糖尿病视网膜病变玻璃体手术干预治疗时机探讨

To discuss the operation opportune of vitrevtomy in diabetic retinopathy

目的探讨糖尿病视网膜病变(DR)增殖期不同阶段玻璃体手术干预的临床效果。方法将我院就诊的增殖期DR患者65例(90只眼),分为增殖晚期、增殖早期,在增殖期不同阶段实施玻璃体手术。所有患者进行术前、术后的视力及眼前节记录,眼底可见者行荧光素眼底血管造影(FFA)、部分患者行三维光学相干断层扫描;术中应用高速玻璃体切割,眼内注入0.02 ml曲安奈德(TA),充分剥离新生血管膜,眼内视网膜激光光凝,如伴有裂孔及视网膜脱离,术后采用眼内气体或硅油填充,其余患者手术结束后玻璃体腔再次注入0.05 m1 TA。结果增殖期DR早期实施玻璃体切割术,术后可最大限度保留患者视力,术中联合应用TA,术后黄斑水肿减轻,加快视功能的恢复。结论增殖期DR患者,应及时进行玻璃体手术;对于DR早期增殖病变,玻璃体手术干预治疗可防止病变发展,有效保护患者的视功能,应做为糖尿病患者玻璃体手术适应证。

Objective To analyze the clinical effects of vitrectomy for the different phase of prolivertive diabetic retinopathy. Methods The clinic data of 65 patients （90eyes） with prolivertive diabetic retinopathy divided into the later and the early stage,performed vitrectomy in different stage of proliferative phase,Recording the anterior segment and the vision acuity before and after operation of all the patients, FFA if the fundus can be viewed and 3 D-OCT of some patients, during operation using high-speed vitrectomy,injecting triamcinolone aceonide （TA ） 0. 02ml, in the operation removed the neovascular membrane and intraoclar photocoagulation, if accomplanying with retina hole or retina detachment postoperation proceeded intraoclar injected gas or silicon oil, other patients intraoclar injected TA 0. 05ml. Results Vitrectomy in the early stage of prolivertive diabetic refinopathy can protect the vision acuity as far as possible,Combined with TA can reduce macular edema ,speeed-up the recovery of vision function. Conclusion Prolivertive diabetic retinopathy should be treated with vitrectomy timely, at the early stege of prolivertive diabetic retinopathy, vitrectomy can avoid it developping, protect a good vision function. So it was an indication of vitrectomy.