糖尿病性白内障病人视网膜病变的治疗探讨

CLINICAL OBSERVATION OF THE TREATMENT FOR DIABETIC RETINOPATHY WITH CATARACT

目的探讨糖尿病性白内障病人的视网膜病变治疗时机及临床效果。方法对120例（189只眼）糖尿病性白内障病人行散瞳眼底检查,45例（79只眼）因严重白内障眼底窥不清。65例（90只眼）接受眼底荧光造影,其中60只眼糖尿病性视网膜病变属于1～2期;30只眼属于3～5期,白内障手术前对其可见区域视网膜进行激光光凝。102例（157只眼）接受了白内障手术,植入人工晶体。白内障手术后有112只眼接受眼底荧光造影检查（包括术前曾行此检查的90只眼）,对其中糖尿病性视网膜病变1～3期病人行局部视网膜光凝治疗,4～5期病人行全视网膜光凝治疗。结果白内障术后眼底造影检查示糖尿病性视网膜病变1～2期40只眼,3期45只眼,4～5期共27只眼。10只眼放弃治疗,62只眼单纯行激光治疗。光凝治疗后随诊6～12个月,4只眼因玻璃体积血行玻璃体切除术,1只眼注入硅油。其他病眼视力稳定或提高,视网膜病变未见明显进展。26只眼发现黄斑水肿明显,玻璃体腔注射曲安奈德4 mg。结论白内障术前及术后及时检查眼底,积极治疗,可控制视网膜病变进展。

Objective To analyze the treatment timing and effect for diabetic retinopathy with cataract. Methods 120 patients （189 eyes） of diabetic cataract were examined fundus after mydriasis before cataract operation. Fundus of 45 cases （79 eyes） were invisible due to cataract. 10 cases （20 eyes） refused fundus fluorescence angiography （FFA）. 65 cases （90 eyes） were made in FFA. Diabetic retinopathy of 60 eyes were in 1--2 stage,the other 30 eyes were in 3--5 stage who were treated with photo-coagulation in visible region before cataract operation. 102 cases （157eyes） were treated with phacoemulsification and intraocular lens implantation. 112 eyes were made in FFA after cataract operation （including 90 eyes which were made in FFA）. Results The retinopathy of 40 eyes were in 1--2 stage, 45 eyes were in 3 stage who were suggested local photo coagulation, 27 eyes were suggested pan retinal photocoagulation in 4--5 stage. 10 eyes gave up treatment. 26 eyes with macular edema who were treated with intravitreous injection with 4 mg triamcinolone acetonide. Following up lasted 6--12 months, among which 4 eyes were treated with vitrectomy according to vitreous hemorrhage. One of these 4 eyes was treated with silicone oil injection. 26 eyes with macular edema were treated with intravitreous injection with triamcinolone acetonide. The others have invariant or improved vision. Conclusion The operation of intraocular lens implantation can accelerate the progression of diabetic retinopathy. So we must ex amine fundus after mydriasis preoperative, or FFA if necessary, photo coagulation in visible region must he performed duly. After the cataract operation, we must carefully check fundus,treat with photo coagulation in time.