全视网膜光凝联合药物治疗糖尿病视网膜病变的临床观察

摘要

OBJECTIVE To investigate the pan-rephotocoagulation (PRP) combined with medication for the treatment for diabetic retinopathy (DR). METHODS Proliferation and pre-proliferation diabetic retinopathy with indications of PRP 158 cases (267 eyes), were divided into four groups. PRP group 38 patients (group A, 62 eyes), by simply PRP therapy;Qiming granule+PRP group 42 patients (group B, 72 eyes), by combined oral Qiming gran-ule with PRP;Dobesilate Ca+PRP group of 40 patients (group C, 69 eyes), by combined oral calcium Dobesilate with PRP;Qiming granule+Dobesilate calcium+PRP group of 38 patients (group D, 64 eyes), by oral Qi Ming particles Dobesilate calcium combined PRP therapy. The effect of treatment was evaluated by the best corrected vi-sual acuity, fundus photography, FFA, OCT examination before treatment and three months after treatment. RE-SULTS Compared with the other 3 groups , after treat-ment the decline of visual acuity of group A had statis-tical significance (t=2.723,P=0.008). The effective rate of visual acuity of group A,B,C,D was 64.5%, 81.9%, 82.6%, 89.1%respectively (χ2=12.922,P=0.005). Effec-tive rate of FFA was 69.4%, 86.1%, 85.5%, 89.1%(χ2=10.528,P=0.015), and effective rate for macular edema was 41.2%, 50.0%, 45.5%, 57.1% (χ2=1.092,P=0.779). CONCLUSIONS PRP combination therapy was not only ef-fective in promoting regression of neovascularization, but also could improve DR-induced vision loss in patients with PRP.%目的：探讨全视网膜激光（PRP）联合口服药物对于糖尿病视网膜病变（DR）中的治疗作用。方法增殖前期及增殖期有全视网膜光凝适应症的糖尿病视网膜病变患者158例（267只眼），分为4组。单纯PRP组（A组）38例（62只眼），予单纯PRP治疗；芪明颗粒+PRP组（B组）42例（72只眼），予口服芪明颗粒联合PRP；羟苯磺酸钙+PRP组（C组）40例（69只眼），予口服羟苯磺酸钙联合PRP；芪明颗粒+羟苯磺酸钙+PRP组（D组）38例（64只眼），口服芪明颗粒、羟苯磺酸钙联合PRP治疗。治疗前及治疗3个月后进行最佳矫正视力、眼底照相、荧光素眼底血管造影（FFA）、光学相干断层扫描（OCT）检查，评价治疗效果。结果 A组治疗后视力有统计学意义的下降（t=2.723，P=0.008），其余3组视力无明显下降（P>0.05）。A、B、C、D组的视力有效率分别为64.5%、81.9%、82.6%、89.1%（χ2=12.922，P=0.005），FFA有效率为69.4%、86.1%、85.5%、89.1%（χ2=10.528，P=0.015），黄斑水肿有效率41.2%、50.0%、45.5%、57.1%（χ2=1.092，P=0.779）。结论 PRP联合羟苯磺酸钙或芪明颗粒可以减轻光凝导致的视力下降，并改善患眼视网膜的缺氧状态，PRP同时联合羟苯磺酸钙及芪明颗粒的效果相对更好。