玻璃体手术治疗增殖性糖尿病视网膜病变的时机和疗效

Occasion choice and efficacy of vitrectomy treatment for proliferative diabetic retinopathy

目的探讨玻璃体切割术治疗增殖性糖尿病视网膜病变的时机和疗效。方法回顾186例（242眼）PDR患者资料,123眼行全视网膜光凝术,119眼行玻璃体切割术,对手术时机和治疗效果进行对比分析。术后随访6~40个月。结果PDRⅣ期、Ⅴ期患者行玻璃体切割手术后视力改善的比例为78.4%,Ⅵ期患者为43.7%;PDRⅣ期患者行全视网膜光凝术治疗后有效率为80.8%,Ⅴ期患者为58.2%;未合并玻璃体出血的Ⅴ期PDR患者,PRP治疗有效率为58.2%,而玻璃体切割术后视力改善者占78.9%。术中并发症主要是医源性裂孔,术后并发症为玻璃体再出血、视网膜脱离、新生血管性青光眼。结论正确把握PDR患者行全视网膜光凝术和玻璃体切割术的时机,才能提高疗效,有效地改善PDR患者的视力。

Objective To explore the occasion choice and efficacy of vitrectomy for treatment of proliferative diabetic retinopathy（PDR）. Methods 186 patients （242 eyes） with PDR were enrolled in this study. Pan-retinal photocoagulation （PRP） was performed on 123 eyes and vitrectomy on 119 eyes. All were followed up for 6 to 40 months. Resuits After vitrectomy, visual acuity was improved in 78.4 % eyes of the Ⅳ and Ⅴ PDR groups and 43.7 % of the Ⅵ PDR group. After PRP, visual acuity was improved in 80.8% eyes of thelV PDR group and 58.2% of the V PDR group. For Ⅴ PDR patients without vitreous hemorrhage, the effective rate of vitrectomy treatment was 78.9% while of PRP it was 58.2%. The main operative complication was iatrogenic retinal holes and the postoperative complications were vitreous re-hemorrhage, retinal detachment and neovascular glaucoma. Conclusion A suitable operative occasion is important for patients with PDR to ensure good visual acuity.