玻璃体切割治疗弥漫性糖尿病黄斑水肿疗效观察

Effect of vitrectomy in the treatment of diffuse diabetic macular edema

目的:研究玻璃体切割治疗弥漫性糖尿病黄斑水肿的临床效果。方法:收集2004-03/2006-07在我院因弥漫性糖尿病黄斑水肿性行玻璃体切割方法治疗的患者23例(23眼),所有患者均严格控制血糖、血压,术前均详细检查视力、眼压、裂隙灯、检眼镜眼底、荧光血管造影(fluorescein fundus angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT),分别记录术前术后1,3,6,12mo视力及黄斑厚度,进行对比,并观察手术后并发症,平均随访14.5±1.2mo。结果:所有患者均顺利进行玻璃体手术治疗,其中有8例患者在曲安奈德(triamcinolone acetonide,TA)辅助下完成玻璃体手术,术前患者平均视力0.24±0.15,术后1,3,6,12mo平均视力0.19±0.14,0.25±0.16,0.28±0.15,0.32±0.19,术后12mo与术前矫正视力对比有显著性差异,术前黄斑厚度平均OCT值438±169μm,术后1,3,6,12mo平均OCT值为317±123,263±87μm,237±6,228±41μm,与术前分别对比均有显著性差异。术中2例出现医源性网膜裂孔,激光封口,无患者术后出现玻璃体出血,虹膜新生血管,视网膜前膜,无患者行白内障手术。结论:玻璃体切割手术治疗弥漫性黄斑水肿可在短期内明显减轻黄斑水肿,并逐步改善患者视功能,其远期效果需进一步观察。

AIM： To study the surgical efficacy of pars plana vitrectomy （PPV） for diffuse diabetic macular edema. METHODS： Pars plana vitrectomy was performed on 23 eyes of 23 cases with diffuse diabetic macular edema, 8 eyes of all underwent TA-assisted PPV, main outcome measures included pre-and post operation optical coherence tomography （OCT） and visual acuity （VA）. Mean follow-up period was 14.5 ± 1.4 months. RESULTS： At last follow-up , 39% of eyes had ≥ 2 line increase in VA,48% of eyes had no improvement in VA, and 13% of eyes had 2 line decrease in VA. mean preoperative vision was 0.24 ± 0.15, Mean visual acuity at 1 month,3 months, 6 months and 12 months postoperatively was 0. 19 ± 0. 14,0. 25 ± 0. 16,0. 28 ± 0. 15,0. 32 ± 0. 19 respectively. Significantly decreased for the postoperative 12 months VA compared to preoperative, The postoperative foveal retinal thickness at 1 month,3 months, 6 months, 12 months was 317 ± 123,263 ± 87,237 ± 69μ m,228 ± 41μm respectively,Significantly thinner than the preoperative foveal retinal thickness （ 438 ± 169μm ）, other postoperative complications reported before were not met in our cases. CONCLUSION： Pars plana vitrectomy for diffuse diabetic macular edema is an effective procedure for reducing the edema thickness and can improve visual acuity gradually, but the long-term efficacy of this method should be observed.