岛状膜手术在晚期增殖性糖尿病视网膜病变中的应用

Island membrane surgery in advanced proliferative diabetic retinopathy Application

目的探讨晚期增殖性糖尿病视网膜病变伴有视盘表面或上、下血管弓表面生长的大片新生血管膜，同时合并玻璃体出血或牵拉性视网膜脱离或牵拉孔源混合性视网膜脱离的玻璃体手术，探究手术中的剥膜技巧及对此类患者玻璃体手术治疗的价值。方法选择晚期增殖性糖尿病视网膜病变患者106例（106眼），男性47例（47眼），女性59例（59眼），年龄44—69岁。早期对膜的处理采用传统的膜钩钩膜及撕膜技术，共55例（55眼），后期采用岛状膜技术，共51例（51眼）。结果两种剥膜技术对术后视力提高岛状膜组好于撕膜组，但因为两组患者都属于晚期患者，最好视力都不超过0．12，多数视力在0．02—0．08之间。但岛状膜技术组术中、术后并发症明显减少，减少了硅油填充率，减少了二次手术的可能。结论岛状膜清除技术处理晚期增殖性糖尿病视网膜病变优于传统撕膜技术，晚期增殖性糖尿病视网膜病变合并大片增殖膜、玻璃体出血及视网膜脱离患者行玻璃体手术后大部分仍能恢复一定视功能，仍有极大的治疗价值。

Objective To investigate the late stage of proliferative diabetic retinopathy with neovascular membrane on the surface of the optic disc or the upper and lower surface of the large blood vessels bow, and the surgery skill for the vitreous hemorrhage or traction retinal detachment or combined traction rhegmatogenous retinal detachment, and to explore surgery techniques of the stripping film, and the treatment value of vitreous surgery on these patients.Methods A total of 106 cases （ 106 eyes） patients with advanced proliferative diabetic retinopathy were included in this study.Male cases were 47 （47 eyes）, female cases where 59 （59 eyes）, age was 44-69 years old.Traditional membrane tear film technology was used on the early treatment of membrane on 55 cases （ 55 eyes） were used this technique, while the island membrane technology was used on the late stage treatment on cases （51 eyes）.Results Visual acuity improved better on island membrane group than the tear film group post-operatively, however, the best visual acuity was not better than 0.12 due to the both group of the patients were on the later stage.The majority of visual acuity was between 0.02-0.08.Intraoperative and post-operative complication was significant lower on the island membrane tech- nology group that decreased the silicone oil fill rate and reduced the possibility of secondary surgery.Conclusions The island membrane technology are better than the traditional technology to remove the film on advanced proliferative diabetic retinopathy, vitreous hemorrhage and retinal detachment.Some visual function is able to restore after vitrectomy so there is still a great therapeutic value.