Clinical Observation Of Laser Photocoagulation For Severe NPDR And Early PDR

Objective:To observe the clinical effects of different photocoagulation plans for severe nonproliferlative diabetic retinopathy(NPDR) and early proliferlative diabetic retinopathy(PDR) with severe macular edema(ME),to analyze the best times and plans for photocoagulation.Methods:1.50 eyes with severe NPDR with severe macular edema were randomly assigned into united group and single group.26 eyes in united group and 24 eyes in single group.United group was performed modified grid photocoagulation combined with panretinal photocoagulation and single group was performed modified grid photocoagulation.Observe the changes of BCVA,OCT,FFA,MF-ERG and visual field after half year's follow-up.2.42 eyes with early PDR with severe macular edema were randomly assigned into united group and single group.22 eyes in united group and 20 eyes in single group.United group was performed modified grid photocoagulation combined with panretinal photocoagulation and single group was performed panretinal photocoagulation.Observe the changes of BCVA,OCT,FFA and visual field after half year's follow-up.Results:1.The results of patients with severe nonproliferlative NPDR with severe ME after photocoagulation:(1) The BCVA of both groups were maintained after photocoagulation,there was no significant difference compared with pre-photocoagulation,the degree of BCVA changes showed no significant difference compared between two groups.(2) The macular edema and central foveal thickness(CFT) had decreased in both groups after photocoagulation,there was significant difference compared with pre-photocoagulation,the degree of CFT changes showed no significant difference compared between two groups.(3) The capillary nonperfusion area had decreased in most of patients in unite group,the capillary nonperfusion area had no change or increased in all of patients in single group.The degree of capillary nonperfusion area changes showed significant difference compared between two groups.(4) The average retinal sensitivity in the 10°and 30°had decreased in united group,there was significant difference compared with pre-photocoagulation.The average retinal sensitivity in the 10°had decreased in single group,there was significant difference compared with pre-photocoagulation.(5)The P1 amplitude and N1 amplitude had decreased after photocoagulation in both groups,there was significant difference compared with pre-photocoagulation, The P1 implicit time was prolonged in ring3,ring4 and quadrant4 in united group. There was significant difference compared with pre-photocoagulation.The P1 implicit time was prolonged in ring 3,ring4 and ring5 in single group.There was significant difference compared with pre-photocoagulation,the degree of changes in amplitude and implicit time of P1,N1 showed no significant difference compared between two groups.2.The results of patients with early PDR with severe ME after photocoagulation:(1) The BCVA of both groups were maintained after photocoagulation,there was no significant difference compared with pre-photocoagulation,the degree of BCVA changes showed no significant difference compared between two groups.(2) The macular edema and central foveal thickness(CFT) had decreased in united group after photocoagulation,there was significant difference compared with pre-photocoagulation.The CFT decreased in single group after photocoagulation,but there was no significant difference compared with pre-photocoagulation.The degree of CFT changes of united group was large than single group.There was significant difference compared between two groups.(3) The neovascular had decreased in both groups after photocoagulation.The degree of neovascular changes showed no significant difference compared between two groups.(4) The average retinal sensitivity in the 10°and 30°had decreased in united group,there was significant difference compared with pre-photocoagulation.The average retinal sensitivity in the 30°had decreased in single group,there was significant difference compared with pre-photocoagulation.Conclusions: 1.For patients with severe NPDR with severe ME,single modified grid photocoagulation and modified grid photocoagulation combined with panrentinal photocoagulation had the same effects in maintaining visual acuity and decreasing macular edema.But united photocoagulation was better than single photocoagulation in decreasing capillary nonperfusion area.2.For patients with early PDR with severe ME,single panrentinal photocoagulation and modified grid photocoagulation combined with panrentinal photocoagulation had the same effects in maintaining visual acuity and decreasing neovascular.But united photocoagulation was better than single photocoagulation in decreasing macular edema.3.Modified grid photocoagulation reduce the average retinal sensitivity in the 10°and panretinal photocoagulation reduce the average retinal sensitivity in the 30°.4.Photocoagulation lead to retinal lesion,the main manifestation of that was P1,N1 amplitude decrease apparently.But modified grid photocoagulation combined panretinal photocoagulation didn't add more retinal function lesion than single modified grid photocoagulation.