Ⅱ型增殖性糖尿病视网膜病变患者行玻璃体切除术的时机与术后视力分析

Timing of vitrectomy for proliferative diabetic retinopathy in cases with type II diabetes mellitus

目的探讨Ⅱ型增殖性糖尿病视网膜病变合并严重玻璃体出血或合并血管纤维增殖引起的视网膜牵拉及牵拉性视网膜脱离情况下，进行玻璃体切除术的手术时机。方法对６４例（７８只眼）Ⅱ型增殖性糖尿病视网膜病变行玻璃体切除术的患者，按术前出血时间和视网膜病变程度各分为两组，进行术后视力恢复情况的比较。结果术后９个月，视力为０．３以上者，在术前出血时间≤６个月组为４２．１％，而在术前出血时间＞６个月组为５．３％，两组间差异有显著性（Ｐ＜０．０１）。术后１年，获得０．５以上视力者，在术前出血时间≤６个月组为３５．７％，而在术前出血时间＞６个月组为７．１％，两组间差异有显著性（Ｐ＜０．０５）；术后获０．３以上视力者，在单纯玻璃体出血合并或不合并局部牵拉性视网膜脱离组为３５．７％，而在大面积牵拉性视网膜脱离组为１６．７％，两组间差异有显著性（Ｐ＜０．０５）。结论Ⅱ型糖尿病患者发生玻璃体出血，应早期手术治疗。对出血时间长、牵拉性视网膜脱离严重的患者，也不应放弃手术治疗。

Objective To determine the timing of vitrectomy for proliferative diabetic retinopathy with severe vitreous hemorrhage, retinal traction and even tractional detachment resulted from fibrovascular membranes in type II diabetes mellitus. Methods According to the preoperative duration of vitreous hemorrhage and severity of diabetic retinopathy, 78 eyes of 64 cases having undergone vitrectomy were diveded into 2 groups for the comparison of postoperative visual acuity. Results After 9 months of follow up, in the group with preoperative vitreous hemorrhage of ≤6 months' duration 42.1% of cases had visual acuity of ≥0.3, while in the group with preoperative vitreous hemorrhage of >6 months' duration 5.3% of cases reached such a level ( P <0.01). After one year, in the group with preoperative vitreous hemorrhge of ≤6 months 35.7% of cases had visual acuity of ≥0.5, while in the group with preoperative vitreous hemorrhages of >6 months' duration, 7.1% ( P <0.05). In the group of vitreous hemorrhage with or without local tractional retinal detachment, 35.7% had visual acuity of ≥0.5, while in the group with large area of tractional retinal detachment, 16.7% ( P <0.05). Conclusion Earlier vitrectomy is preferable for type II diabetes mellitus with vitreous hemorrhage, and the operative treatment should not be abandoned for the patients with vitreous hemorrhage of longer duration and severe tractional retinal detachment.