玻璃体切割联合超声乳化人工晶体植入术治疗增生性糖尿病视网膜病变

Pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy

目的探讨增生性糖尿病视网膜病变(proliferativediabeticretinopathy,PDR)合并白内障患者的玻璃体手术中,同期行白内障超声乳化摘除和后房型人工晶状体植入术的临床效果。方法回顾性分析合并不同程度白内障的增生性糖尿病视网膜病变患者36例(46只眼)实施玻璃体切割联合晶状体超声乳化人工晶体植入手术,其中气体填充15只眼,硅油填充5只眼;观察术后视力改善程度及术中术后并发症。结果术后随访3￣24个月,平均6个月。术后33只眼(74%)视力有不同程度的改善,不变7只眼,下降6只眼;术后视力低下者多伴有明显的糖尿病黄斑水肿、硬性渗出或缺血。术后并发症包括虹膜后粘连17只眼(35%),视网膜脱离3只眼(7%),晶体后囊混浊12只眼(26%),角膜上皮延期愈合12只眼(26%),玻璃体出血14只眼(30%)。结论玻璃体切割联合晶状体超声乳化人工晶体植入术治疗合并不同程度白内障的增生性糖尿病视网膜病变是安全有效的,可使大多数患者视力改善,避免玻切术后并发白内障再次手术;糖尿病黄斑病变是影响术后视力提高的主要原因。

[Objective] To evaluate the effectiveness and safety of combined pars plana vitrectomy （PPV） and phacoemulsification （PEA） with intraocular lens （IOL） implantation in patients with concomitant cataract and proliferative diabetic retinopathy （PDR）. [Method] This retrospective study consisted of 46 eyes of 36 patients with proliferative diabetic retinopathy and clinically significant lens opacities. Pars plana vitrectomy was combined with phacoemulsification and intraocular lens implantation ;Gas tamponade was employed in 15 eyes; Silicone oil tamponade was employed in 4 eyes; Postoperative Visual acuity, and complications was analyzed. [Result] The postoperative follow-up interval ranged from 3 to 24 months （mean, 6 months）. The postoperative visual acuity improved in 74% of patients, was unchanged in 15%, and was worse in 11%. Diabetic macular abnormalities present to eyes with low visual acuity. Postoperative complications included posterior synechia of the iris in 17 eyes （35%）, and retinal detach- ment in 3 eyes （8%）, opacification of the posterior capsule in 12 eyes （26%）, delayed corneal epithelial healingl2 eyes （26%）, vitreous hemorrhage 14 eyes （30%）. [Conclusion] This study suggests that the combined operation of PPV, PEA, and IOL implantation is safe and effective for PDR coexisting with cataract. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation. Diabetic macular abnormalities is main reason preventing visual acuity raising.