增生性糖尿病视网膜病变玻璃体手术后视功能改善及脱盲率分析

Visual acuity of patients of proliferative diabetic retinopathy after vitreoretinal surgery

目的 观察增生型糖尿病视网膜病变（PDR）玻璃体切割手术后视功能变化及脱盲率.方法 回顾分析临床确诊为PDR并行玻璃体切割手术的300例患者384只眼的临床资料.其中,256例患者332只眼符合1973年世界卫生组织（WHO）制定的盲目标准.所有患者手术前后均进行了最佳矫正视力、眼底检查.治疗后随访3～20个月.根据糖尿病视网膜病变不同分期,对比分析手术前后视力变化情况及脱盲率.结果 384只患眼中,手术后视力较手术前提高者271只眼.占70.6%.Ⅳ～Ⅴ期及Ⅵ期患眼视力改善率分别为85.5%和54.3%,差异有统计学意义（χ~2=44.78,P〈0.05） 其中Ⅵ期早、中晚期治疗组手术后视力〉0.05患眼所占比例分别为82.8%和64.6%,差异有统计学意义（χ~2=4.861,P〈0.05）.332只盲眼中.手术后脱肓201只眼,占60.5% 未脱盲131只眼,占39.5%.结论 玻璃体切割手术能有效改善PDR患者视力,使部分糖尿病性盲目患者脱盲.

Objective To observe the visual acuity of different stages of proliferative diabetic retinopathy （PDR） eyes after vitrectomy and analyze the risk factors of blindness. Methods A total of 384 eyes of 300 patients underwent vitrectomy for PDR were followed up. All cases were divided into three groups according to different stage of PDR （stage Ⅳ, stage Ⅴ and stage Ⅵ）, the effect of vitrectomy were compared among these groups. Results The final visual acuity increased in 271 eyes （70.6%）, among them there were 171 eyes （185.5%） in stage Ⅳ-Ⅴ, and 100 eyes （54.3%） in stage Ⅵ, and there was statistical difference between these two groups （χ~2 = 44.78, P〈 0.05）. 82. 8% of early-treated and 64.6% of middle/late- treated stage Ⅵ patients had postoperative visual acuity above 0. 05 （χ~2= 4. 861, P〈0. 05）. 39.5% （131 eyes） of 332 eyes with diabetic blindness was still blind after surgery. Conclusion Visual acuity can be improved in the majority of PDR eyes after vitrectomy, early prevention and early treatment are the keys to avoid diabetic blindness.