增殖型糖尿病性视网膜病变玻切术后再出血原因分析及处理

Analysis and treatment of rehemorrhage in eyes with proliferative diabetic retinopathy after vitrectomy

增殖型糖尿病视网膜病变(PDR)玻璃体切割术后再出血是影响视力预后的一个重要因素。我们对91例100眼术后出血进行分析,结果如下:一周内最易出血,50%以上在一月内。控制好血糖,半年内未出血则以后很少出血。原因有纤维血管膜残端、新生血管、晶体手术、硅油取出,激光不足。出血多难吸收时,积极治疗可改善视力预后。我们认为术中彻底剥膜,术后及时行眼底血管荧光造影(FFA),激光光凝,尽量保留晶体及后囊,无晶体眼慎重取油可有效防出血。

Rehemorrhage should not be neglected since it affects patientsvision with PDR after vitrectomy.The results of our study on 100 eyes of 91 patients show that:①The most dangerous period of hemorrhage is within one week after vitrectomy,and 50% of hemorrhage occurs within a month.Under proper control of blood glucose there is little possibility of hemorrhage 6 months after the operation.②The reasons of rehemorrhage are residual of fibrous vescular membrane,new vesculization,cataract operation,removal of silicon oil,insufficiency of laser photocoagulation.③Proper treatment after hemorrhage can obviously improve the patients vision.The results indicate that completely peeling of membrane during operation,timely fundus fluorescein angiography,retinal laser photocoagulation,keeping the lens with the utmost effort,and being prudent in removal of silicon oil can prevent rehemorrhage after vitrectomy.