Objective To investigate the early influences of laser photocoagulation on retinal function in diabetic retinopathy(DR)． Methods The multifocal electroretinograms (MERG) of 30 eyes with DR (phase Ⅲ～Ⅳ) were tested with visual evoked response image system IV b efore,and the 3rd day and the 7th day after laser photocoagulation． Results Three days after photocoagulation, the latency of N1 prolonged in the central macula 5deg; area and superionasal quadrant．Th e response densities of N1,P1 and N2 markedly reduced, and most significant changes occurred in the central macula 5deg; area and then in the central 10deg;area． There were also differences in the changes of the amplitude of N1 and P1 in diff erent quadrants ．The changes of visual acuity were positively related to the de crease of amplitudes of N1,P1 and N2 in the macula． Conclusion The reduction of response densities in MERG reveals functional damage in diabetic retina occurring early after photocoagulation．The functional damage in macula induced indirectly by photocoagulation may explain the reduction of visual acuity after panretinal photocoagulation in some degree． (Chin J Ocul Fundus Dis, 2001,17:181-183)
Objective To observe visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation. Method The data of 39 ROP patients (73 eyes) who received laser photocoagulation were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex were matched with ROP group. There were 24 males (45 eyes) and 15 females (28 eyes) in ROP group, with an average age of (7.0±1.28) years. The first laser treatment was carried out at postnatal age (PA) of (38.74±3.82) weeks, the birth weight (BW) of (1402.33±369.61) g and the number of laser burns was (517.86±277.40). The control group included 7 females (13 eyes) and 6 males (12 eyes), with an average age of (7.17±0.96) years. The age (t=0.691) and gender (χ2=1.425) were comparable between the two groups (P=0.491, 0.233). The data of patients and controls were retrospectively analyzed including best corrected visual acuity, refractive examination, automated perimetry test. The differences of the mean deviation (MD) of visual field and the spherical equivalent (SE) between these two groups were comparatively observed. ROP patients were divided into no VF loss group (MD≤2 dB) and VF loss group (MD＞2 dB), mild VF loss group (MD≤6 dB) and moderate VF loss group (MD＞6 dB) according to the results of automated perimetry test, the differences of gestational age (GA), PA, BW, number of laser burns and SE between these groups were comparatively observed. Results The MD in ROP group and control group were 4.87±5.12 dB and 1.27±3.34 dB, respectively; the difference between the two groups was statistically significant (t=–4.01,P＜0.001). The subgroup analysis showed that BW, number of laser burns, and SE were significantly different between no VF loss group and VF loss group (t=2.074, –1.996, –2.162;P=0.042, 0.026, 0.034); while the GA was not significantly different between these two groups (t=1.973,P=0.052). The difference of PA was not statistical significant different between mild VF loss group and moderate VF loss group (t=2.03,P=0.051) and SE was significantly different between the above two groups (t=3.283,P=0.002). For refractive outcomes, the BW and ROP stage correlated with SE significantly (r=–0.304, –0.387;P=0.015, 0.002). The mean BCVA in ROP group was 0.84±0.23, and 59 eyes (91.2%) with BCVA better than 0.5. Conclusion Laser treatment for ROP tends to have less effect on long term refractive status and VF loss, with good visual outcome.
The concept of treatment of central serous chorioretinopathy (CSC) has evolved dramatically with the understanding of its pathogenesis recently. Initial clinical studies found that CSC is a selflimiting disease, therefore advocated observation or conservative treatment was recommended. Further study by fundus fluorescein angiography indicated that CSC results from barrier dysfunction of retinal pigment epithelium (RPE), which leads to serous RPE and (or) neural retinal detachment; so laser photocoagulation to close RPE leakage points by its thermal effects became a strategy to treat CSC. Recent study by indocyanine green angiography revealed that increased choroidal vascular permeability can induce high hydrostatic pressure and focal RPE detachment, resulting in mechanical breakage of RPE barrier. This is likely the major pathological basis of CSC now. Photodynamic therapy (PDT) can embolize of choroidal capillary network, thereby preventing choroidal leakage caused by increased capillary permeability, and thus cure the CSC. However the search for the pathogenesis and better treatment of CSC is far from over. Further investigation about pathogenesis and improvement of diagnosis and treatment is an urgent need for clinic work, but also major issues challenging the wisdom of an ophthalmologist. We need to work together to promote more and better clinical and basic research of CSC.
Objective To observe the efficacy and safety of laser photocoagulation on highrisk prethreshold versus threshold retinopathy of prematurity (ROP). Methods Ninety-seven ROP infants (186 eyes)， which included 88 high-risk prethreshold ROP eyes and 98 threshold ROP eyes, were enrolled in this study. Among the 186 eyes, 70 eyes were zone one and 116 eyes were zone two. Laser photocoagulation with 810 nm wavelength using binocular indirect ophthalmoscopy was used in all the infants under general anesthesia. Follow-up ranged from 35 to 852 days with a mean of (316±274) days. The degree of retinopathy alleviation and progress were observed. ResultsAmong the 186 eyes, complete abatement of retinopathy was found in 168 eyes (90.3%), local retinal detachment was found in eight eyes (4.3%). The complete abatement of retinopathy was found in 84 eyes both in high-risk prethreshold group (95.5%) and threshold group (85.7%), while progressive retinopathy was found in four eyes in the high-risk prethreshold group (4.5%) and 14 eyes in threshold group (14.3%). The difference in recovery rate was statistically significant between two groups (χ2=3.98,P＜0.05). The abatement of retinopathy was found in 56 eyes in zone one group (80.0%) and in 112 eyes in zone two group (96.6%), while progression of retinopathy was found in 14 eyes in zone one group (20.0%), and 14 eyes in zone two group (3.4%). The number of eyes with progressive retinopathy in zone one group was obviously higher than that in zone two group. The difference was statistically significant (χ2=11.86，P＜0.01). No treatmentrelated complications were observed during the follow-up period. ConclusionsLaser photocoagulation is effective in treating high-risk prethreshold and threshold ROP. Early intervention could improve prognosis. There was no treatment-related complication during the follow-up duration.
ObjectiveTo observe the different effect of 23G vitrectomy surgery assisted with intravitreal injection of ranibizumab and pan-retina photocoagulation in severe proliferative diabetic retinopathy (PDR) treatment. MethodsA total of 60 patients (78 eyes) with severe PDR diagnosed were enrolled and divided into intravitreal injection of Lucentis group (Group A, 22 patients, 28 eyes), pan-retina photocoagulation group (Group B, 18 patients, 20 eyes) and control group (Group C, 20 patients, 30 eyes), all of them received 23G vitreoretinal surgery. The average operation time, iatrogenic hiatus, the use of filler and electric coagulation, postoperative bleeding and best corrected visual acuity in three months were comparatively analyzed among the three groups. ResultsThe operation time in the three group was (67.429±11.243), (77.762±10.435), (106.839±20.724) min respectively, the differences of A vs C and B vs C were statistically significant(t=8.940, 5.928; P < 0.05). Five eyes needed electric coagulation in Group A, 6 eyes in Group B, and 24 eyes in Group C, the differences of A vs C and B vs C were all statistically significant (χ2=19.955, 10.505;P < 0.05). Four eyes used the filler in Group A, 3 eyes in Group B, and 23 eyes in Group C, the differences of A vs C and B vs C were all statistically significant (χ2=18.099, 14.083;P < 0.05). The difference of iatrogenic hiatus and postoperative bleeding was no significance among the three groups (P > 0.05). The best corrected visual acuity of 3 months after surgery in the three group is (0.383±0.122), (0.251±0.067), (0.104±0.044) respectively, the differences of A vs C and B vs C were all statistically significant(t=11.909, 13.616;P < 0.05). ConclusionThe intravitreaI injection of ranibizumab or pan-retina photocoagulation treatment before the vitrectomy surgery is very effective, both of them can shorten the operation time, reduce electric coagulation and use of filler, and improve patients' eyesight.