1型与2型糖尿病患者增生型糖尿病视网膜病变玻璃体视网膜手术疗效比较

Comparison of efficacy of vitreoretinal surgery on proliferative diabetic retinopathy in patients with type 1 and type 2 diabetes

目的：观察1、2型糖尿病（DM）对玻璃体视网膜手术治疗增生型糖尿病视网膜病变（PDR）疗效的影响。方法：回顾分析1999年6月至2003年10月期间451例因PDR接受玻璃体视网膜手术治疗的DM患者的临床资料，其中1型71例，2型380例。手术后至少随访14个月，平均随访时间29个月。通过两组患者视力、虹膜新生血管（INV）发生与消退、新生血管性青光眼（NVG）发生与消退、视网膜在位率和复位率等观察指标的比较，观察DM不同分型对PDR患者玻璃体视网膜手术治疗效果的影响。结果：手术前1型DM患者中Ⅵ期PDR、视力在0．1以下眼、INV、NVG等严重PDR眼病变的比例均高于2型DM患者。手术治疗后视力提高者的比例，1型DM患者中占64．8％，2型DM患者中占72．4％（P=0．196）；1型DM患者PDR合并虹膜红变眼75．0％手术后虹膜红变消退，而2型患者中这一比例为60．0％（P=0．678）；手术后新增虹膜红变眼的比例，1型DM患者为6．3％，2型DM患者为5．6％（P=0．822）。无论是1型还是2型DM患者NVG眼压都得到有效控制，仅1例1型DM患者的INV未消退；手术前存在视网膜脱离的PDRVI期患者中，一次手术后视网膜复位率1型DM患者为87．2％，2型DM患者为89．8％（P=0．611）。一次手术后视网膜保持在位率，1型DM患者为90．1％，2型DM患者为93．4％（P=0．323）。结论：PDR患者的DM分型对玻璃体视网膜手术治疗的效果没有明显影响。

Objective To observe the efficacy of vitreoretinal surgery on proliferative diabetic retinopathy （PDR） in patients with type 1 and type 2 diabetes mellitus （DM）. Methods Retrospectively analyzed the clinical data of 451 patients with DM （71 with type 1 and 380 with type 2） who underwent PDR from June 1999 to October 2003. The follow-up period was at least 14 months with the average of 29 months. The pre- and post-operative visual acuity, progression and regression of iris neovascular （INV）, neovascular glaucoma （NVG）, and the reattached and being-attached rate of retina were observed and compared between the two groups. The effect of different types of DM on vitreoretinal surgery for PDR were observed. Results The preoperative data showed that the number of type 1 DM patients with severe PDR was more than the type 2 DM patients ： the rate of grade VI PDR, the visual acuity lower than 0.1, INV and NVG were all higher that which in type 1 DM patients. The increased ratio of postoperative visual acuity was 64.8% （46/71） in type 1 DM patients and 72.4% （275/380） in type 2 DM patients （P= 0. 196）. There were 75.0% patients with PDR combined with rubeosis iridis in type 1 DM group and 60. 0% in type 2 DM group （P=0. 678）;the rate of new rubeosis iridis after surgery was 6.3% in type 1 DM group and 5.6% in type 2 DM group （P= 0. 822）. The intraocular pressure of NVG eyes were all controlled effectively in both type 1 and type 2 DM groups, and INV did not regressed only in one case in type 1 DM group. In the patients with preoperative retinal detachment at the grade VI of PDR, the rate of retinal reattachment after one-off operation was 87.2% in type 1 DM group and 89.8% in type 2 DM （P= 0. 611）; the rate of retina being-attachment after one-off surgery were 90. 1% in type 1 DM group and 93.4% in type 2 DM group, respectively （P=0. 323）. Conclusion There was no obvious difference of surgical efficacy on the two types of DM in patients with PDR.