玻璃体切除联合硅油填充术治疗糖尿病视网膜病变的愈后及并发症分析

Prognosis and complications for vitrectomy combined with intraocular silicone oil tamponade on diabetic retinopathy: report of 98 eyes

目的探讨玻璃体切除联合眼内硅油填充术治疗糖尿病视网膜病变的视力改善及并发症分析。方法回顾性分析98眼行玻璃体切除联合眼内硅油填充术治疗的糖尿病视网膜病变患者,观察术后视力恢复情况和术后并发症,分析影响视力预后的因素,探讨术后并发症与并发性疾病等其他因素的关系。结果 98眼患者行玻璃体术后视力提高率为66.33%,术后并发黄斑病变组的视力改善率(55.26%)显著低于无黄斑病变组的视力改善率(73.33%)(P<0.05)。高血压组和糖尿病肾病组的高眼压、新生血管、再出血、黄斑水肿和黄斑前膜的发生率显著高于无高血压组和无糖尿病肾病组(P<0.05)。血糖控制状况良好和较短的糖尿病史可以显著降低高眼压、再出血、黄斑水肿和黄斑前膜的发生率(P<0.05)。高血压组和糖尿病肾病组的高眼压、新生血管、再出血、黄斑水肿和黄斑前膜的发生率显著高于无高血压组和无糖尿病肾病组(P<0.05)。血糖控制状况良好和较短的糖尿病史可以显著降低高眼压、再出血、黄斑水肿和黄斑前膜的发生率(P<0.05)。结论玻璃体切除联合眼内硅油填充术治疗糖尿病视网膜病变可以显著提高患者术后视力,且术后是否并发黄斑病变是影响视力改善的重要因素,术后并发症的发生率与并发性疾病、血糖控制和糖尿病史密切相关。

Objective To evaluate the therapeutic effect and complications of vitrectomy combined with intraocular silicone oil tamponade on diabetic retinopathy. Methods A retrospective analysis of 98 eyes of 74 patients with diabetic retinopathy, who underwent vitrectomy combined with intraocular silicone oil tamponade therapy in our department from september 2013 to september 2014, was performed to observe the postoperative visual acuity and complications. The influencing factors of the visual prognosis were analyzed, and the correlation between postoperative complications and concurrent diseases was explored. Results The postoperative visual acuity improving ratio was 66. 33% in all the eyes, nevertheless, the patients with macular retinopathy showed significantly lower postoperative visual acuity （55.26%） than the ones without macular retinopathy（73.33% ） （ P 〈 0. 05 ）. The incidences of high intraocular pressure, neovascularization, rebleeding, macular edema and macular epiretinal membrane in the hypertension group and the diabetic nephropathy group were significantly higher than those in the non-hypertension group and the non-diabetic nephropathy group （P 〈 0. 05 ）. Good glycemic control and short history of diabetes could significantly reduce the incidences of high intraocular pressure, rebleeding, maeular edema and macular epiretinal membrane （P 〈 0. 05 ）. Conclusion The procedure of vitrectomy and intraocular silicone oil tamponade has good therapeutic effect on diabetic retinopathy, especially for visual acuity improvement. Macular retinopathy is one important influencing factor of postoperative visual acuity. The postoperative complications are significantly correlated with some concurrent diseases, glycemic control and diabetes history.