Baptista Pedro Manuel, Marta Ana Ambrósio, Heitor João, José Diana, Almeida Daniel, Ribeiro António, Barbosa Irene
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Instituto de CIências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
Diabetes Metab Syndr Obes. 2021 Mar 19;14:1281-1293. doi: 10.2147/DMSO.S301747. eCollection 2021.
To address the long-term visual function after bilateral pan-retinal photocoagulation (PRP) and its impact in real life, namely on visual field (VF) legal criteria to drive. To determine potential predictors related to clinical factors and treatment strategies.
Observational cross-sectional study. Eyes from diabetic patients diagnosed with diabetic retinopathy who underwent bilateral PRP, with or without macular treatments and with visual acuity legal criteria for non-professional driving were randomly assigned. Main outcomes were: demographic and clinical data including best corrected visual acuity; binocular visual field (EBST-Esterman Binocular Suprathreshold Test, Humphrey analyzer3); contrast sensitivity (CS-Metrovision-MonPack3); light scattering in the retina (HD Analyzer, Visiometrics).
Seventy-one diabetic patients included (44 men and 27 women), with a mean age of 62.2±11.8 years. PRP was performed, on average, 9.7±6.9 years before the study. The average EBST Score was 85.8±17.0 and the average CS (2-5cpd) was 19.5±2.9 dB in photopic and 14.2±4.1 dB in mesopic conditions. Through a multivariate regression model, after adjusting to the clinical and demographic factors as possible confounders, we found that treatment factors associated with worse results were the use of Argon laser for the EBST Score, the very confluent PRP for the number of non-viewed points in the central 30°x20° of the EBST and the presence of macular treatments for the CS tests. According to Portuguese law, 79% (n=56) of patients had minimal EBST amplitudes for non-professional driving.
The functional results achieved in our sample are compatible with an active life, allowing most of the patients included to overcome the requirements of Portuguese legislation for driving light vehicles, namely at the level of the binocular visual field. These results highlight the role of PRP in the treatment of diabetic retinopathy in an era with evolving less aggressive laser options.
探讨双眼全视网膜光凝（PRP）后的长期视觉功能及其在现实生活中的影响，即对驾驶视野（VF）法定标准的影响。确定与临床因素和治疗策略相关的潜在预测因素。
观察性横断面研究。随机选取诊断为糖尿病性视网膜病变且接受过双眼PRP治疗、有或无黄斑治疗且视力符合非职业驾驶法定标准的糖尿病患者的眼睛。主要结局指标包括：人口统计学和临床数据，包括最佳矫正视力；双眼视野（EBST - Esterman双眼超阈值测试，Humphrey分析仪3）；对比敏感度（CS - Metrovision - MonPack3）；视网膜光散射（HD分析仪，Visiometrics）。
纳入71例糖尿病患者（44例男性和27例女性），平均年龄62.2±11.8岁。PRP平均在研究前9.7±6.9年进行。平均EBST评分为85.8±17.0，平均CS（2 - 5cpd）在明视条件下为19.5±2.9 dB，在中视条件下为14.2±4.1 dB。通过多变量回归模型，在将临床和人口统计学因素作为可能的混杂因素进行调整后，我们发现与较差结果相关的治疗因素包括：使用氩激光会影响EBST评分，PRP光斑过度融合会影响EBST中央30°x20°范围内未观察到的点数，以及存在黄斑治疗会影响CS测试结果。根据葡萄牙法律，79%（n = 56）的患者双眼视野振幅最低，符合非职业驾驶要求。
我们样本中获得的功能结果与积极生活相适应，使大多数纳入的患者能够满足葡萄牙驾驶轻型车辆的立法要求，即在双眼视野方面。这些结果凸显了在激光治疗选择逐渐变得不那么激进的时代，PRP在糖尿病性视网膜病变治疗中的作用。
