Cohen B Z, Wald K J, Toyama K
Retina Associates of New York, NY 10021, USA.
Am J Ophthalmol. 1997 Apr;123(4):515-23. doi: 10.1016/s0002-9394(14)70177-1.
To determine the applicability of laser segmentation for severing fibrovascular tissue and hyaloid interfaces in the treatment of tractional complications of proliferative diabetic retinopathy.
A prototype neodymium:yttrium-lithium-fluoride (Nd:YLF) picosecond pulse photodisruptive laser was used in eight eyes (seven patients) with proliferative diabetic retinopathy as part of a Food and Drug Administration-approved phase 1 protocol. There were three indications for treatment: type I: distortion and shallow elevation of the macular caused by taut, adherent, posterior hyaloid interface (two eyes); type II: traction retinal detachment involving the fovea (two eyes); and type III: fovea-threatened, traction retinal detachment (four eyes). Traction release was accomplished by laser segmentation of the detached hyaloid interfaces and fibrotic, contracted proliferative tissue. The Nd:YLF uses low pulse energy (0.10 mJ, 1,000 pulses per second for 10 consecutive seconds) that allows tissue cutting near the retinal surface.
Both type I eyes had relief of traction forces; visual acuity improved from 20/400 to 20/50 in one eye; the other remained stable. Of the two type II eyes, one had anatomic reattachment of the fovea with improvement in visual acuity (hand movements to 20/50); the second required vitrectomy. Of the four type III eyes, all had anatomic improvement; three maintained pretreatment acuity; the fourth eye developed vitreous hemorrhage at 6 months and underwent vitrectomy. Three treatments (two eyes) caused vitreous hemorrhage that resulted in a transient drop in acuity (1 to 2 lines). No patient developed a retinal break or choroidal hemorrhage.
In a small pilot study, the Nd:YLF laser segmented proliferative tissue near the retinal surface and elevated hyaloid interfaces. In selected cases, this may enable flattening of traction retinal detachment or release of retinal distortion.
确定激光分割在治疗增殖性糖尿病视网膜病变牵引性并发症时切断纤维血管组织和玻璃体界面的适用性。
一台钕：钇锂氟化物（Nd:YLF）皮秒脉冲光破坏激光原型机被用于8只眼睛（7名患者）的增殖性糖尿病视网膜病变治疗，这是美国食品药品监督管理局批准的1期方案的一部分。有三种治疗指征：I型：由紧绷、粘连的后玻璃体界面导致的黄斑变形和浅隆起（2只眼）；II型：累及黄斑的牵引性视网膜脱离（2只眼）；III型：黄斑受威胁的牵引性视网膜脱离（4只眼）。通过对脱离的玻璃体界面和纤维化、收缩的增殖组织进行激光分割来实现牵引松解。Nd:YLF使用低脉冲能量（0.10 mJ，每秒1000次脉冲，连续10秒），可在视网膜表面附近进行组织切割。
两只I型眼的牵引力均得到缓解；一只眼的视力从20/400提高到20/50；另一只保持稳定。两只II型眼中，一只黄斑实现解剖复位，视力改善（从手动视力提高到20/50）；另一只需要进行玻璃体切除术。四只III型眼中，所有眼均有解剖学改善；三只维持术前视力；第四只眼在6个月时发生玻璃体积血并接受了玻璃体切除术。三次治疗（两只眼）导致玻璃体积血，导致视力短暂下降（1至2行）。没有患者发生视网膜裂孔或脉络膜出血。
在一项小型试点研究中，Nd:YLF激光分割了视网膜表面附近的增殖组织并抬高了玻璃体界面。在选定的病例中，这可能使牵引性视网膜脱离变平或解除视网膜变形。
