Mr. Li is 50 years old and found that he has been diagnosed with diabetes for 5 years. He was shocked by a fundus examination. The doctor said that he had stage IV retinopathy and had a fundus laser surgery (retinal photocoagulation). It is said that the eyes are not particularly uncomfortable. What is going on?
Ophthalmology is very professional. This article explains the basic process of photocoagulation treatment and precautions before and after surgery through nine questions.
NO.1: How terrible is diabetic retinopathy?
Diabetic retinopathy (DR) is one of the common chronic complications of diabetes and one of the leading causes of blindness in adults. In 2014, the Department of Ophthalmology of the Chinese Medical Association Ophthalmology Branch issued the “Guidelines for the Clinical Diagnosis and Treatment of Diabetic Retinopathy in China”, stating that the prevalence of DR in diabetic patients in mainland China is 23%. The main risk factors for DR include: hyperglycemia or obvious blood sugar fluctuations. Hypertension, hyperlipidemia, long duration of diabetes, diabetic nephropathy, obesity, susceptibility genes, etc.
Guidelines: Once the type 2 diabetes is diagnosed, the first comprehensive eye exam will be performed as soon as possible. In addition, because diabetic nephropathy is closely related to diabetic retinopathy, it is also necessary to check for the presence or absence of DR with microalbuminuria. Mr. Li’s fundus examination found microaneurysms, cotton plaques, and new blood vessels, but did not affect the macular area, so there was no significant change in visual acuity, but if the lesion invaded the macular area, it would cause a decrease in central vision. In other words, the degree of macular degeneration is not balanced with other parts of the retina, but 74.2% of patients with diabetic retinopathy with macular degeneration may affect vision.
Diabetic patients should seek medical attention as soon as possible if they have the following eye symptoms: decreased vision, distorted vision, flashing when looking at things, increased floating objects in front of the eyes, and black shadows on things.
NO.2: What are the routine ophthalmic examinations for sugar nets?
Initial physical examination: vision, intraocular pressure, slit lamp, fundus examination. There are: In the fundus examination:
1. Free of the fundus photography: easy to operate, non-ophthalmologists can operate, screening for early diabetic fundus lesions is necessary.
2. Fluorescein fundus angiography (FFA): dynamic observation of fundus capillary circulation, leakage, and photocoagulation effects before and after comparison.
3. Optical coherence tomography (OCT): more sensitive and intuitive, better for the diagnosis of retinal macular edema (DME) and tracking laser photocoagulation.
NO.3: Sugar network is divided into several stages The frequency of review?
In general, there is a process of fundus diseases caused by diabetes. The worse the blood sugar control, the faster the symptoms of the disease. This process is based on the Guidelines for Clinical Diagnosis and Treatment of Diabetic Retinopathy in China. It is “I-VI period”. (I-III period is non-proliferative phase, IV-VI phase is proliferative phase) Phase I (mild non-proliferative phase): only capillary angiomatous bulge. Phase II ( Moderate non-proliferative phase): between mild non-proliferative and severe, may have hemorrhage, hard oozing or cotton plaque. Stage III (severe non-proliferative phase): ≥20 bleeding points per retinal hemorrhage, or At least 2 quadrants have a defined venous bead-like change, or at least 1 quadrant found Microvascular abnormalities in the omentum. Stage IV (early hyperplasia): retinal neovascularization or optic neovascularization (these neovascularization itself has defects, it only bleeds and does not supply nutrients). Stage V (fibrous proliferative phase): appears Fibrous membrane, or with preretinal hemorrhage or vitreous hemorrhage. Stage VI (late proliferative): traction retinal detachment with fibrovascular membrane, combined with vitreous hemorrhage, including neovascularization of the iris and anterior horn.
After the first examination of the fundus: patients with no diabetic retinopathy should be examined once a year; patients with mild to moderate diabetic retinopathy should be examined every six months and treated accordingly. The fundus examination is shown below:
NO.4: How does photocoagulation work?
Human Eyeball is like a fully automatic camera The retina is like a negative film. The fundus photocoagulation uses a thermal effect to form a dense photocoagulation point on the retina. Photocoagulation can seal the leakage point to reduce retinal edema and vitreous hemorrhage; photocoagulation can also destroy the capillary occlusion area to reduce neonatal life. The formation of vascular factors promotes the retraction of existing neovascularization, prevents the regeneration of new blood vessels, and preserves existing visual functions.
NO.5: Indications for photocoagulation therapy
Patients with proliferative diabetic retinopathy must undergo photocoagulation therapy. Vitreous hemorrhage, traction retinal detachment involving preretinal hemorrhage and fibrovascular proliferation, and early iris neovascularization are indications for surgery. Specific treatment and follow-up indications also need to be determined by the ophthalmologist. At present, the mainstream treatment methods of sugar net mainly include: laser treatment, as well as intraocular or periocular injection of anti-VEGF drugs or hormones, which can effectively reduce retinal edema and hemorrhage, and can also prepare for laser or surgical treatment. When the lesion progresses to the proliferative phase, a large amount of hemorrhage, proliferative membrane, and even retinal detachment occur, the patient needs surgery.
NO.6: Is it painful during photocoagulation? It usually does not hurt, and there is eye swelling during treatment. This symptom is more common in patients who have repeated treatment. Lubricating drugs can be relieved of discomfort if needed.
NO.7: The basic process of photocoagulation treatment?
1. After the patient arrives, the nurse will give the patient a dilated drug on the side of the operation side, and if necessary, give lubrication. drug.
2. After the dilated sputum meets the requirements, the patient enters the laser treatment room, sitting in front of the treatment chair according to the doctor’s request, turning off the illumination and setting the posture, as shown below, to maintain a stable posture during treatment, eyes Do not rotate at will.
3. Cooperate with the doctor as required, pay attention to control the blink of an eye. After the surgeon adjusts the parameters of the photocoagulation treatment, the lens of the instrument is placed in the eyelid of the patient’s side. Since photocoagulation requires laser light to enter the eye, it is required to keep eyes wide open. However, due to the patient’s initial treatment tension, and the lens that is not suitable for the instrument is stuck in the eyelid, some patients may have frequent blinking, affecting treatment. At this time, we should pay attention to adjusting the psychology, relieve tension, and pay attention to treatment.
4. The number of photocoagulation points per treatment is about 200 to 300 points. The standard total retinal photocoagulation ranged from a PD-2PD (1PD= 1.5 mm) outside the optic papilla to the fundus outside the equator, leaving the posterior pole between the optic disc macular and the superior and inferior vascular arches without photocoagulation. The photocoagulation number of the whole retina is 1200 to 1600 points, and monocular photocoagulation generally takes 3 to 4 times. The specific number is determined by the severity of retinopathy, the size of the non-perfusion area, and the range of neovascularization. The spot size should generally be 500 μm, 200 μm within the temporal vascular arch, 0.1 to 0.2 s for laser exposure, and 3 to 5 times for total retinal photocoagulation. The spots are separated by 1 to 2 spot diameters.
NO.8: Precautions after photocoagulation treatment?
1. Generally, each eye needs to be divided into 3~4 times to complete the laser treatment of the entire fundus, once every half month. Every time you need a large pupil before the laser, it is best to be accompanied by your family when you come to the hospital. The patient may have mild eye discomfort at the same time as or after the laser. Postoperative patients may experience mild vision loss or blurred vision, which usually improves on their own for hours or days.
2. Before photocoagulation, the doctor should pre-operatively talk with the patient, sign the informed consent form, explain the post-operative precautions, such as laser treatment similar to cauterization, need a crusting process, after treatment It is best to avoid watching TV, mobile phones or excessive use of the eyes on the day, avoid doing low-head exercise and exercise, and avoid washing your face with hot water. After that, be careful not to drink too much.
3. The purpose of the laser is not to improve vision, but to prevent the progression of diabetic fundus lesions. After 2 months of laser completion, it is necessary to review the fundus fluorescent blood vessels and, if necessary, supplement the laser treatment. Because diabetes can not be cured, the lesions in the fundus need to be diagnosed under the supervision of an ophthalmologist for a long time, and promptly treated.
NO.9: What should I pay attention to?
What are the precautions? Diabetes patients usually pay attention to blood sugar, blood pressure, blood lipid management, while treating other complications, reducing high leakage response of retinal blood vessels, delaying progress. The most important preventive measures for diabetic fundus lesions are: early screening, early detection, and early treatment.