Cruess A F, Williams J C, Willan A R
Department of Ophthalmology, Queen's University, Kingston, Ont.
Can J Ophthalmol. 1988 Oct;23(6):262-6.
We treated 69 eyes of 44 patients who had clinically significant macular edema with argon or krypton laser photocoagulation or both. The mean initial visual acuity was 20/40. Patients were followed for 6 to 63 (mean 19.7 +/- 11.0) months. There was a mean loss of three letters in acuity, but the difference between initial and final acuity was not statistically significant. In 43 eyes the acuity remained within two lines of the initial acuity, in 17 there was a loss of two lines or more, and in 9 the acuity improved by two lines or more. The initial acuity correlated highly to the final acuity (p less than 0.0001). Multiple linear regression showed that pretreatment existence of macular ischemia or diffuse macular edema or both, when adjusted for initial acuity, age, insulin dependence and duration of diabetes mellitus, was predictive of poorer final acuity than in patients without ischemia or diffuse edema. The results support a consensus that macular edema should be treated early. In view of the conflicting experimental and clinical studies of grid techniques of photocoagulation and the role of the krypton laser, further clinical studies of the treatment of diabetic macular edema are warranted.
我们对44例患有具有临床意义的黄斑水肿的患者的69只眼睛进行了氩激光或氪激光光凝治疗，或两者联合治疗。初始平均视力为20/40。患者随访了6至63个月（平均19.7±11.0个月）。视力平均下降了三个字母，但初始视力与最终视力之间的差异无统计学意义。43只眼睛的视力保持在初始视力的两行以内，17只眼睛视力下降了两行或更多，9只眼睛视力提高了两行或更多。初始视力与最终视力高度相关（p<0.0001）。多元线性回归显示，在调整初始视力、年龄、胰岛素依赖程度和糖尿病病程后，黄斑缺血或弥漫性黄斑水肿或两者同时存在，预示着最终视力比无缺血或弥漫性水肿的患者更差。结果支持黄斑水肿应早期治疗的共识。鉴于光凝格子技术以及氪激光作用的实验和临床研究结果相互矛盾，有必要对糖尿病性黄斑水肿的治疗进行进一步的临床研究。
