晶状体摘除对糖尿病视网膜病变玻璃体视网膜手术效果的影响

The influence of lens extraction on the outcomes ofvireoretinal surgery for diabetic retinopathy

目的探讨晶状体摘除对糖尿病视网膜病变（diabetic retinopathy，DR）玻璃体视网膜手术（vitreoretinal surgery，VRS）效果的影响。方法回顾性分析2001年2月至2007年8月行VRS的68例（80只眼），比较摘除晶状体眼同人工晶状体眼与保留晶状体眼的手术效果，随访5～63个月，平均（12．24±9．13）月。结果术后87．27％的保留晶状体眼及68％的摘除晶状体眼视力提高或不变（χ^2=4．191，P=0．062）；再次VRS率在保留晶状体组为12．7％，摘除晶状体组20％（χ^2=0．713，P=0．502）；解剖复位率在保留和摘除晶状体眼分别为92．73％和96％（χ^2=0.314，P=1.000）；保留晶状体组和摘除晶状体组各2只眼发生虹膜红变（χ^2=0．689，P=0．585），差异均无统计学意义。术后摘除晶状体组前房纤维素性渗出和黄斑水肿的发生率较保留晶状体组增加，差异有统计学意义（P〈0．05）。结论晶状体摘除并不增加DR再次VRS率和虹膜红变的发生率，但术后前房纤维素性渗出和黄斑水肿的发生率增加。

Objective To investigate outcomes of lens extraction during the vireoretinal surgery （VRS）for diabetic retinopathy.Methods 80 eyes from 68 cases of diabetic retinopathy accepted VRS from February 2001 to August 2007.The eyes remained phakic after VRS were compared with the eyes that were either aphakic or pseudophakic （nonphakic）postoperatively.The average follow-up time was （12.24± 9.13） months.Results Visual acuity kept stable or improved in 87.3% of the phakic eyes and 72% of the nonphakic eyes （χ^2=4.191 ,P =0.062）.The reattachment rate are 92.73% and 96% in the phakic and nonphakic groups separately （χ^2=0.314, P =1 .000 ）.Rubeosis iridis developed in 2 phakic eyes and two nonphakic in the phakic and nonphakic groups （χ^2=4.513, P =0.095）.The rates of fibrous exudation of anterior chamber and macular edema were higher in nonphakic group than in phakic group（P 〈0.05 ）.Conclusions Lens extraction does not influence the outcomes of diabetic 1 vitreoretinal surgery, and there are no significant difference in vitreoretinal reoperation rate and the outcomes of anatomy and visual acuity between the two groups.