糖尿病视网膜病变视盘新生血管膜的分类及处理

Treatment ofneovascular membrane on the disk in the surgery of proliferative diabetic retinopathy

目的探讨视盘新生血管膜的分类及糖尿病视网膜病变（diabetic retinopathy，DR）手术中，不同类型新生血管膜的处理和预后。方法回顾分析2000年11月至2006年2月手术的有随访记录的增生性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）患者139例（148只眼），术前均行眼部超声检查，行标准的三切口玻璃体切割术。术中钝性剥膜配合电凝止血处理新生血管膜。结果视盘新生血管膜的发病率75％（111／148只眼）大部分患者视力较术前有不同程度的提高，视力改善率86．5％。视盘新生血管膜有二种来源三种类型，不同类型的膜在B超图像上有不同的表现。膜基本部能够被完整剥离，但不同类型的膜因其与视盘及周围视网膜粘连程度不同，其剥离难易不同，且有不同的出血倾向。结论PDR视盘新生血管膜存在二种来源三种类型，在手术中视盘部的新生血管膜大多能被剥离，术前超声了解其分类可估计手术难度及预后。复杂的易反复出血的患者宜采用硅油作为眼肉填充。

Objective To evaluate the effect of the neovascular membrane peeling on optic disk. Methods A total 148 eyes suffering PDR which experienced vitrectomy were studied.All the eyes were examined with B-scan ultrasonography before operation.The neovascular membrane on optic disk was peeled and endo-diathermy was performed to prevent hemorrhage.Results The incidence rate of disk neovascular membrane is 75% （111/148 eyes ）.Visual improvement achieved in most of the eyes.The neovascular membranes on optic disk come from two different sources and are classified into three types.Every type that can be identified according to the characteristics of B-scan ultrasonography has different influence upon the tendency of hemorrhage and adhesion.Conclusion In the surgery ofPDR, most of the neovascular membranes on the optic disk can be peeled off.B-scan ultrasonography before operation is a good way to predict the difficulty and prognosis.Silicone oil is useful in management of complicated and rehemorrhagic cases.