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糖尿病视网膜病变的激光治疗方式

Laser Treatment Modalities for Diabetic Retinopathy.

作者信息

Pande Gauri S, Tidake Pravin

机构信息

Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.

出版信息

Cureus. 2022 Oct 7;14(10):e30024. doi: 10.7759/cureus.30024. eCollection 2022 Oct.

Abstract

Diabetes is a chronic progressive metabolic disorder that is caused by the body's inability to regulate blood glucose levels. If uncontrolled, it can lead to various complications. Among its various complications, long-term diabetes leads to diabetic retinopathy (DR). It is a disease involving blood vessels and the destruction of retinal nerves. It is usually classified into two types: proliferative diabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR). It progresses and causes loss of vision. The leading cause of loss of vision is diabetic macular edema (DME). The argon laser is used as a modality in the management of PDR. There are various types of laser photocoagulation, such as peripheral retinal laser photocoagulation, focal macular laser photocoagulation, and grid photocoagulation. DR results in various adverse consequences such as vitreous hemorrhage, fibrosis, traction, detachment of the retina, and glaucoma. To assess DR, a detailed fundus examination with a slit lamp biomicroscope needs to be done. Seven-standard field stereoscopic-color fundus photography needs to be done for documentation and follow-up. Patients with diabetes mellitus (DM) type 1 have a greater risk of suffering from DR. Another major complication of the condition is DME, which is characterized by an increase in the permeability of vessels and the thickening of the central part of the retina along with the accumulation of hard exudates on the macula. This article discusses various laser therapy modalities for the treatment of DR, their types, mechanisms, and aims. Clinical features of DR include abnormal dilatation of capillaries, and outpouchings in the form of microaneurysm from the capillary wall are one of the earliest and most dangerous changes; later, non-perfusion of the retina occurs, which is associated with cotton wool spots and blot hemorrhages. In patients suffering from PDR and maculopathy, peripheral retinal laser photocoagulation is used as a mode of intervention.

摘要

糖尿病是一种慢性进行性代谢紊乱疾病,由人体无法调节血糖水平所致。若不加控制,会引发各种并发症。在其诸多并发症中,长期糖尿病会导致糖尿病性视网膜病变(DR)。这是一种涉及血管及视网膜神经破坏的疾病。它通常分为两种类型:增殖性糖尿病性视网膜病变(PDR)和非增殖性糖尿病性视网膜病变(NPDR)。病情会发展并导致视力丧失。视力丧失的主要原因是糖尿病性黄斑水肿(DME)。氩激光被用作治疗PDR的一种方式。有多种类型的激光光凝术,如周边视网膜激光光凝术、黄斑局灶性激光光凝术和格栅光凝术。DR会导致各种不良后果,如玻璃体出血、纤维化、牵拉、视网膜脱离和青光眼。为评估DR,需要使用裂隙灯生物显微镜进行详细的眼底检查。需要进行七标准视野立体彩色眼底摄影以用于记录和随访。1型糖尿病(DM)患者患DR的风险更高。该病症的另一个主要并发症是DME,其特征是血管通透性增加、视网膜中央部分增厚以及黄斑区出现硬性渗出物积聚。本文讨论了治疗DR的各种激光治疗方式、它们的类型、机制和目的。DR的临床特征包括毛细血管异常扩张,而毛细血管壁上以微动脉瘤形式出现的囊状膨出是最早且最危险的变化之一;随后,会出现视网膜无灌注,这与棉絮斑和点状出血有关。在患有PDR和黄斑病变的患者中,周边视网膜激光光凝术被用作一种干预方式。

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