合并白内障的增殖性糖尿病视网膜病变联合手术效果及并发症的观察

Observation of the Effect of Combined Surgery for the Treatment of Proliferative Diabetic Retinopathy and Cataract

目的探讨合并白内障的增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)玻璃体切除联合超声乳化人工晶状体植入术的临床效果及并发症。方法回顾性分析2006年3月至2010年1月本院手术治疗的合并白内障的增生性糖尿病视网膜病变患者228例(236只眼)。其中男108例,女120例;年龄39~76岁,平均57岁;糖尿病史2~26年,眼病史1月至8年。结果术后平均随访时间分别为6~16个月。患者手术后视力较术前提高198眼(占86.8%),不变15眼(占6.6%),术后视力下降或光感消失15眼(占6.6%);术后前房内纤维素渗出膜形成有76眼(占33.3%),观察1 w^3个月完全吸收的有65眼(占85.5%);术后角膜水肿、上皮愈合慢有52只眼(占22.8%),有1例经3个月的营养角膜治疗,最终恢复正常;术后发生后囊膜混浊(后发障)156眼(占68.4%),于取油同时处理,不注油者单行YAG激光切除;术后网膜再增殖,牵引网脱,或玻璃体再积血者16例(占7.0%),均再行玻璃体切割术联合剥膜、注油。结论玻璃体切除联合超声乳化白内障摘除人工晶状体植入术治疗增殖性糖尿病视网膜病变是安全、有效的,术后并发症少,能迅速恢复患者视力,减少患者多次手术的痛苦。

Objective To explore the efficacy and complications of vitrectomy combined with phacoemulsifieafion and intraocular lens implantation for the treatment of proliferative diabetic retinopathy （PDR） and cataract. Methods A retrospective analysis was done to 228 patients （236 eyes） with PDR and cataract from March 2006 till January 2010. Among them, 108 patients were male, and 120 patients were female. They varied in age from 39 to 76 year-old, and the average age was 57. The history of diabetes mellitus was 2 ~ 26 years, and with PDR for one month to eight years. Results A total of 236 eyes were followed up for 6 ~ 16 months. Visual im- provement was achieved in 198 eyes （86.8%）, the same with preoperation in 15 eyes （6. 6% ）, and declined or disappeared of light perception in 15 eyes （6. 6% ）. 76 eyes （33.3%） were found after operation with cellulose exudation membrane in anterior chamber, of those 65 eyes （85.5%） were absorbed in from one week to three months. Cornea edema and delayed healing of cornea epithelial cell were found in 52 eyes （22. 8% ）, of those one eye was cured in three months, posterior capsule opacification were found in 156 eyes （68.4%）, and being removed with taking silicone oil or by YAG. 16 patients （7.0%） were found after operation with retinal proliferation and tractional detachment or blood deposit in vitreous body, and all the eyes were done vitrectomy combined with stripping membrane and silicone oil tamponade. Conclusions The surgery of vitrectomy combined with phacoemulsificafion and intraocular lens implantation for the treatment of proliferative diabetic retinopathy （PDR） and cataract is safe and effective. There are fewer post-operation complications. The visual acuity can be restored quickly after operation. The patients can avoid operation.