糖尿病视网膜病变黄斑牵拉视网膜脱离的手术治疗

Surgical results of diabetic traction retinal detachment involving the macula

目的 报告增殖性糖尿病视网膜病变黄斑部牵拉性视网膜脱离的手术结果。方法 对2 0 0 0年 3月～ 2 0 0 3年 4月初次采用玻璃体切除 ,并追踪观察 6个月以上的 49例 5 1眼 ,术后解剖复位率 ,视力预后进行回顾性研究。结果 手术后解剖学复位 5 1眼中 41眼 ,占 80 3 % ,最终视力提高2 4眼 ( 4 7% ) ,不变 16眼 ( 3 1 3 % ) ,下降者 11眼 ( 2 1 7% ) ,术中医源性裂孔 2 9眼 ( 5 6 9% ) ,术后视力 0 1以上者多为黄斑脱离≤ 2个月 ,为 12眼中 6眼 ( 5 0 % ) ,与 2个月以上者 ( 3 9眼中 5眼 ,占 2 8% )相比有显著性差异。结论 在增殖性糖尿病性视网膜病变黄斑部牵拉性视网膜脱离患者中 ,黄斑视功能低下者较多 ,为了提高术后视力 ,早期玻璃体手术是必要的。

Objective To evaluate the results of vitrectomy for diabetic traction retinal detachment involving the macula.Methods A retrospective study was conducted of 49 patients (51 eyes) with diabetic traction retinal detachment involving the macula.The patients had undergone their initial operation during the period from March 2000 to April 2003 and had been followed-up for more than 6 months postoperatively.We evaluated anatomical attachment rate and prognosis of vision for these cases.Results At the final examination,the postoperative visual acuity was impoved in 24 eyes(47%),unchanged in 16 eyes(31.3%),decreased in 11 eyes(21.7%),with anatomical reattachment in 41 of 51 eyes(80.3%).Iatrogenic retinal breaks occurred in 29 eyes (56.9%).Visual acuity of 0.1 or better was obtained in 6 (50%) of 12 eyes with macular detachment less than ≤2 months,but only 5 (2.8%) of 39 eyes with macular detachment more than 2 months and the difference was significant.Conclusions To achieve better postoperative visual acuity in eyes with diabetic traction retinal detachment involving the macula,early vitrectomy (before macular function deteriorates) is strongly recommended.