不同术式治疗增殖性糖尿病视网膜病变的疗效分析

Analysis of the curative effect of different surgical methods on proliferative diabetic retinopathy

目的评价玻璃体切除联合超声乳化人工晶状体植入术(联合手术)和单纯玻璃体切除术治疗增殖性糖尿病视网膜病变的临床效果。方法回顾性分析了33例(41眼)行联合手术与36例(42眼)行单纯玻璃体切除治疗的增殖性糖尿病视网膜患者,手术前后的眼部病情、视力及手术并发症等临床资料。平均随访时间分别为20月和21月。结果2组患者手术后视力较均术前提高,但2组之间差异无统计学意义;联合手术组术前虹膜新生血管在术后1～2月内完全消退(5眼),单纯玻璃体切除组只有1眼完全消退(P<0.05);联合手术组有9眼术后前房内纤维素渗出膜形成,单纯玻璃体切除组只有1眼,差异有统计学意义(P<0.05);联合手术组有7眼术后形成虹膜后粘连,单纯玻璃体切除组只有1眼(P<0.05);联合手术组有4眼术后再行玻璃体切除术,占9.8%,单纯玻璃体切除有8眼占19%(P>0.05)。结论联合手术治疗增殖性糖尿病视网膜病变是安全有效的,早期恢复患者的视力,避免再次手术,但联合手术后前房炎性反应、虹膜后粘连的发生率较高。

Objective To compare the effect of vitrectomy combined with phacoemnlsification, intraocnlar lens implantation （ combined vitrectomy ）, and pars plana vitrectomy alone on retinal disorders resulting from diabetic retinopathy. Methods The clinical data, vision, and complications of 33 patients （41 eyes） who underwent combined vitrectomy and 36 patients （42 eyes） who underwent vitrectomy alone retrospectively analyzed. The average follow-up was 20 months and 21 months respectively. Results Final visual acuity were all improved in the two groups but there were no significant difference between them. Five eyes with preoperative iris neovascularization was completely fade away within 1-2 months in combined vitrectomy group, while only 1 eye in vitrectomy alone group （ P 〈 0. 05 ）. Nine eyes were found postoperative fibrin formation in combined vitrectomy group and only 1 eye in vitrectomy alone group （P 〈 0. 05 ）. Seven eyes occurred posterior synechia in combined vitrectomy group and 1 eye in vitrectomy alone group （P 〈 0.05 ）. Four eyes （9.8%） required a repeat vitrectomy in combined procedure group, while 8 eye（ 19% ） in vitrectomy alone group （ P 〉0.05）.Conclusion Combined phacomulstfication, tntraocular lens implantation with vitrectomy （combined vttrectomy）is safe and effective in treating patients with proliferative diabetic rettnopathy. It could avoided second operation and help earlier visual rehabilitation, but It may Increase the incidence of fibrin formation and posterior synechia of the Iris.