影响糖尿病黄斑水肿局部/格栅样光凝治疗 2 年后视力改善或恶化的相关因素。
Factors associated with improvement and worsening of visual acuity 2 years after focal/grid photocoagulation for diabetic macular edema.
机构信息
Joslin Diabetes Center and Department of Ophthalmology, Harvard Medical School, Cambridge, Massachusetts, USA.
出版信息
Ophthalmology. 2010 May;117(5):946-53. doi: 10.1016/j.ophtha.2009.10.002. Epub 2010 Feb 1.
PURPOSE
To identify factors associated with the visual acuity outcome after focal/grid photocoagulation for diabetic macular edema (DME) among eyes randomized to the focal/grid photocoagulation treatment group within the Diabetic Retinopathy Clinical Research Network (DRCR.net) trial comparing triamcinolone with focal/grid laser.
DESIGN
Multicenter, randomized, clinical trial.
PARTICIPANTS
Three hundred thirty eyes with DME assigned to the focal/grid photocoagulation group, visual acuity 20/40 to 20/320, and optical coherence tomography (OCT) central subfield thickness > or =250 microns.
METHODS
Eyes were treated with a protocol-defined photocoagulation technique, which was repeated at 4-month intervals for persistent or recurrent edema. Separate logistic regression models were used to evaluate the associations of demographic, clinical, OCT, and fundus photographic variables with visual acuity improvement or worsening of > or =10 letters from baseline to 2 years. The association of the initial visual acuity outcome after treatment with the subsequent visual acuity course also was evaluated.
MAIN OUTCOME MEASURES
Visual acuity measured with the electronic Early Treatment Diabetic Retinopathy Study method.
RESULTS
Worse baseline visual acuity was the only factor found to be associated with more frequent visual acuity improvement (P<0.001), and both greater baseline OCT-measured retinal volume (P = 0.001) and better baseline visual acuity (P = 0.009) were found to be associated with more frequent visual acuity worsening. Visual acuity outcomes were similar in eyes with and without prior macular or panretinal photocoagulation. The initial visual acuity outcome at 4 months was not generally predictive of the subsequent course. Many eyes that worsened > or =10 letters from baseline to 4 months subsequently improved, and many eyes that initially improved, subsequently worsened.
CONCLUSIONS
At this time, focal/grid photocoagulation remains the standard management for DME and these results do not alter this paradigm.
目的
在糖尿病视网膜病变临床研究网络（DRCR.net）试验中，比较曲安奈德与局部/格栅激光治疗糖尿病黄斑水肿（DME），识别与局部/格栅光凝治疗组随机眼视力结局相关的因素。
设计
多中心、随机、临床试验。
参与者
330 只 DME 眼，分配到局部/格栅光凝组，视力 20/40 至 20/320，光学相干断层扫描（OCT）中央子场厚度>或=250 微米。
方法
采用方案定义的光凝技术治疗眼，对于持续或复发的水肿，每 4 个月重复一次。分别使用逻辑回归模型评估人口统计学、临床、OCT 和眼底照相变量与视力改善或从基线到 2 年恶化>或=10 个字母的相关性。还评估了治疗后初始视力结果与随后视力过程的相关性。
主要观察指标
用电子早期糖尿病视网膜病变研究方法测量视力。
结果
较差的基线视力是唯一与更频繁的视力改善相关的因素（P<0.001），基线 OCT 测量的视网膜体积越大（P=0.001）和基线视力越好（P=0.009），视力恶化的频率越高。有或没有先前黄斑或全视网膜光凝的眼视力结果相似。4 个月时的初始视力结果通常不能预测随后的病程。许多从基线到 4 个月恶化>或=10 个字母的眼随后有所改善，许多最初改善的眼随后恶化。
结论
目前，局部/格栅光凝仍然是 DME 的标准治疗方法，这些结果并没有改变这一模式。
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