| ObjectiveSelect the diabetic retinopathy patients who suffer from macular edema,then treat them in two different methods:only panretinal photocoagulation and panretinal photocoagulation combined with intravitreal injection of vascular endothelial growth factor inhibitor,then obverse their clinical efficacy and safety.MethodA total of 41 patients(61 eyes)who underwent non-proliferative diabetic retinopathy(stage III)or proliferative diabetic retinopathy(stage IV)with fucal or diffuse macular edema were enrolled in our hospital from September 2015 to July 2016.14 of them were male patients and 27 of them were female patients,their average age was 54.21 ± 9.61.In gerenal,there were 24 patients in the laser group,a total of 38 eyes,included 10 male patients and 14 female patients,their average age was 53.00 ± 8.75.They were treated with retinal photocoagulation once a week in the outpatient,totally 3-4 times can complete panretinal photocoagulation.There were 17 patients in the combination group,a total of 23 eyes,included 4 male patients and 13 female patients,their average age was 56.13 ± 10.88.They injected vascular endothelial growth factor inhibitor(21 eyes inject Conbercept,2 eyes inject Lucentis)into the vitreous cavity in the operating room once a month,a total of 2 times.One week after the first intravitreal injection,complete panretinal photocoagulation in the outpatient step by step,the method is the same as the laser group.The best corrected visual acuity was recorded before the treatment by standard logarithmic visual acuity chart,and we also use this chart to record the changes of the best corrected visual acuity at 1 week,1 month and 3 months after the treatment.At the same time,we used optical coherence tomography to record the total macular volume and the retinal thickness in macular area at the same time periods.At last,those data were input into statistical software SPSS17.0,then use this software to analysized them one by one,observe the efficacy.ResultIn the laser group,the best corrected visual acuity was relatively stable and no significant improvement or decrease after panretinal photocoagulation(P> 0.05).The mean retinal thickness and total volume in the macular area were significantly increased(P <0.05)at 1 week after the operation,1 month after the operation and 3 months after the operation,and the change was most significant at 1 month after the operation.The data dropped a little at 3 months postoperatively,but still slightly higher than the preoperative level.The central retinal thickness in the macular area was increased in varying degrees at 1 week and 1 month after the operation,differences were statistically significant(P <0.05),and then returned to the preoperative level basically at 3 months after the operation(P> 0.05).In the combined group,the best corrected visual acuity has slightly increased compared to the preoperative level,the mean retinal thickness,central retinal thickness and total volume in the macular area were decreased at diffierent periods after operation(P <0.05),and the differences were statistically significant(P <0.05).Conclusion(1)Panretinal photocoagulation can prevent eyes from deterioration,vision decreation,is an classic and effective way to treat diabetic retinopathy.It may increase macular edema in a short term,but it will improve over time,it can be restored to the preoperative level.(2)Intravitreal injection of vascular endothelial growth factor inhibitor combined with panretinal photocoagulation can treat diabetic retinopathy significantly,improve macular edema and the best corrected vision acuity,and in addition,it is relatively safe.(3)Optical coherence tomography is good at non-contact,non-invasive,high-resolution and quantitative analysis,etc.,it can show the changes of retinal thickness and total volume in macular area objectively,it is suitable for the follow-up of patients with diabetic retinopathy. |
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