The long-term effects of laser photocoagulation treatment in patients with diabetic retinopathy - The early treatment diabetic retinopathy follow-up study
The long-term effects of laser photocoagulation treatment in patients with diabetic retinopathy - The early treatment diabetic retinopathy follow-up study
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DOI：
10.1016/s0161-6420(03)00579-7
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发表时间：
2003-09-01
期刊：
影响因子：
13.7
通讯作者：
Schachat, AP
中科院分区：
文献类型：
--
作者：
Chew, EY;Ferris, FL III;Schachat, AP
目的：评估糖尿病视网膜病变患者激光光凝治疗的长期自然史和效果。设计：对最初在约翰霍普金斯临床中心登记的214名存活患者进行随访研究，早期治疗糖尿病视网膜病变研究（ETDRS），这是一项旨在评估激光光凝和阿司匹林治疗糖尿病视网膜病变患者的临床试验。早期治疗糖尿病视网膜病变研究在约翰霍普金斯临床中心登记的患者进行了完整的眼科检查，包括最佳矫正视力测量，眼底照片，并在整个7年的研究医疗问卷调查。他们有相同的检查，在最后的长期随访访视在国家眼科研究所，国立卫生研究院，13至19.5年后，最初的激光光凝（中位数，16.7年）。次要结果是糖尿病视网膜病变的进展和其他眼科手术的需要。结果：在1989年的原始ETDRS结束时存活的214例患者中，130例（61%）在复查时死亡。在84名幸存者中，71名（85%）在美国国立卫生研究院进行了长期随访。在长期随访检查中，42%的患者视力为20/20或更好，84%的患者视力为20/40或更好。与基线相比，20%的患者在随访时较好的眼睛中有中度视力丧失（视力丧失3行或更多）。仅1例患者双侧视力为20/200。他患有继发于年龄相关性黄斑变性的视力丧失。无患者出现严重视力丧失（低于5/200）。在最初研究的ETDRS结束访视时患有重度非增殖性糖尿病视网膜病变或更严重的患者的所有初始未治疗的眼睛接受了散射光凝治疗。43%双侧和22%单侧行局灶性光凝。白内障手术在31%的患者，玻璃体切除术在17%，青光眼手术在patient.Conclusions：如前所述，糖尿病视网膜病变患者的死亡率远高于一般人群。对于那些幸存者，积极的后续行动，治疗时指出，似乎与维持良好的长期视力的大多数患者。激光散射光凝术与长期随访的需求似乎很高。(C)2003年，美国眼科学会。
Objectives: To evaluate the long-term natural history and effects of laser photocoagulation treatment in patients with diabetic retinopathy.Design: Follow-up study of the 214 surviving patients enrolled originally at the Johns Hopkins Clinical Center for the Early Treatment Diabetic Retinopathy Study (ETDRS), which was a clinical trial designed to evaluate the role of laser photocoagulation and aspirin treatment in patients with diabetic retinopathy.Methods: Early Treatment Diabetic Retinopathy Study patients enrolled in the Johns Hopkins Clinical Center had complete eye examinations, including best-corrected visual acuity measurements, fundus photographs, and medical questionnaires throughout the 7-year study. They had the same examinations at the final long-term follow-up visit at the National Eye Institute, National Institutes of Health, 13 to 19.5 years after the initial laser photocoagulation (median, 16.7 years).Main Outcome Measures: The major outcomes were mortality and the rates of moderate and severe vision loss. The secondary outcomes were progression of diabetic retinopathy and need for other eye surgery.Results: Of the 214 patients who were alive at the end of the original ETDRS in 1989, 130 (61%) were deceased at the time of the re-examination. Of the 84 who were alive, 71 (85%) were examined at their long-term follow-up visit at the National Institutes of Health. At the long-term follow-up examination, 42% had visual acuity of 20/20 or better, and 84% had visual acuity of 20/40 or better in the better eye. Compared with baseline, 20% of patients had moderate vision loss (loss of 3 lines or more vision) in the better eye at follow-up. Only one patient had visual acuity of 20/200 bilaterally. He had visual acuity loss secondary to age-related macular degeneration. No patient had severe vision loss (worse than 5/200). All the initially untreated eyes of patients who had severe nonproliferative diabetic retinopathy or worse by the time of the ETDRS closeout visit of the original study received scatter photocoagulation treatment. Focal photocoagulation was performed in 43% bilaterally and 22% unilaterally. Cataract surgery was performed in 31% of the patients, vitrectomy in 17%, and glaucoma surgery in one patient.Conclusions: As previously reported, the mortality rate of patients with diabetic retinopathy is much higher than that of the general population. For those who survived, aggressive follow-up, with treatment when indicated, seems to be associated with maintenance of good long-term visual acuity for most patients. The need for laser scatter photocoagulation with long-term follow-up seems to be high. (C) 2003 by the American Academy of Ophthalmology.