玻璃体手术治疗增生型糖尿病视网膜病变544眼疗效分析

Analysis of result of vitrectomy for proliferative diabetic retinopathy in 544 eyes

目的观察玻璃体手术治疗增生型糖尿病视网膜病变(PDR)的疗效及并发症。方法对455例(544眼)行玻璃体手术治疗的PDR连续性病例进行回顾性分析,比较使用不同眼内填充物的结果。结果544眼中视力≥0.02者由术前的267眼(49.1%)增加到术后的444眼(81.6%),其中视力≥0.1者由术前的110眼(20.2%)增加到术后的283眼(52.0%);总视网膜在位眼数499眼(91.7%),其中灌注液组高达96.2%;白内障发生率在灌注液组最低,为7.9%(18/227),硅油组最高,为21.0%(17/81),气体组为14.8%(16/108);术后玻璃体出血者气体组16眼(11.6%),硅油组硅油取出后24眼(20.2%),灌注液组59眼(20.6%)。结论对于无视网膜裂孔及新生血管并发症危险的PDR患者,玻璃体手术保留灌注液即可获得良好预后;术前存在视网膜脱离的PDRⅥ期并非选择硅油或气体的指征。

Objective To study the effect and complications of vitrectomy in proliferative diabetic retinopathy （PDR） eyes. Methods 455 consecutive patients（544 eyes） who underwent vitrectomies for proliferative diabetic retinopathy were retrospectively analysed. The results of different tamponade groups were compared. Results In 544 eyes, the numbers of eyes with visual activity （VA） ≥0.02 were increased from 267 （49.1% ）to 444 （81.6 % ）after surgery, and the numbers of eyes with VA≥0. 1 increased from 110 （20.2%）to 283（52.0%）. Postoperatively, 499 eyes （91.7%） achieved the attached retinas, and it is even higher in irrigation group（96.2 %）. The rate of postoperative cataract was lowest（7.9 %, 18/227） in irrigation group and highest in silicone oil group（21.0 %, 17/81）, and the rate was 14.8%（16/108） in gas group. The 16 eyes （11.6%） in gas group and 59 eyes （20.6%） in irrigation solution group encountered postoperative vitreous hemorrhage respectively. After silicone oil was extracted, 24 eyes （20.2 %） encountered postoperative vitreous hemorrhage in silicone oil group. Conclusions For the PDR patients without retinal break and the risk of neovascularization, a good prognosis can be expected even the irrigation solution was kept after vitreous surgery. The preexisting retinal detachement of PDRⅥ stage is not the indication for selecting silicone oil or intraocular gas tamponade.