晶状体超声乳化联合玻璃体手术治疗合并白内障的增生性糖尿病视网膜病变

Phacoemulsification combined with pars plana vitrectomy for eyes with cataract and proliferative diabetic retinopathy

目的分析晶状体超声乳化联合玻璃体手术治疗合并白内障的增生性糖尿病视网膜病变(PDR)的疗效。设计回顾性临床病例系列。研究对象123只合并不同程度白内障的PDR患眼。方法对123只合并不同程度白内障的PDR患眼实施晶状体超声乳化联合玻璃体手术治疗,同时I期植入人工晶状体(IOL),观察术后视力改善程度及术中术后并发症。主要指标术后视力改善程度、术后并发症发生率。结果123眼均实施晶状体超声乳化联合玻璃体手术,并同时一期植入IOL于囊袋内。随访时间3￣21月(平均10个月)。99眼(81%)术后均有不同程度的视力改善。其中93眼(76%)术后视力提高2行或以上。术后无明显角膜水肿和角膜内皮失代偿发生。1例I型糖尿病患者术后6个月发生新生血管性青光眼;1眼术后发生视网膜脱离,再次手术后复位;4眼因玻璃体腔出血再次手术。术后视力无明显改善或视力提高不足2行的病例均合并不同程度的糖尿病黄斑病变。结论晶状体超声乳化联合玻璃体手术是提高合并白内障的PDR患者视力的有效手段。糖尿病黄斑病变是影响术后视力提高的主要因素。(眼科,2006,15:198-201)

Objective To evaluate the clinical results of phacoemulsification combined with pars plana vitrectomy for eyes with cataract and proliferative diabetic retinopathy. Design Non-controlled retrospective case series study. Participants 123 eyes with proliferative diabetic retinopathy （PDR） and cataract. Methods Phacoemulsification, posterior chamber intraocular lens （PCIOL） implantation combined with pars plana vitrectomy were done in 123 eyes with proliferative diabetic retinopathy （PDR） and cataract. Postoperative vision, number of secondary procedures and surgical complications were analyzed. Main Outcome Measures Postoperative visual improvement and associated complications. Results All 123 eyes underwent combined surgery. The average follow-up was l0 months. 99 eyes （81%） experienced postoperative vision improvement of varying degrees. Vision improved by 2 lines or more in 93 eyes （76%）. No apparent corneal edema or corneal decompensation were encountered. One patient with type 1 diabetes developed neovascular glaucoma 6 months after surgery. Retinal detachment occurred in 1 eye and reoperated. Vitreous hemorrhage requiring secondary procedure happened in 4 eyes. All 24 eyes （ 19% ） without vision improvement were found to be with diabetic maculopathy. Conclusions Phacoemulsification combined with pars plana vitrectomy can be used as an effective surgical tool to improve visions in patients with PDR and cataract. Diabetic maculopathy is the major cause of poor visual improvement. （ Ophthalmol CHN, 2006, 15：198-201 ）