玻璃体切割联合C_3F_8填充治疗糖尿病视网膜病变Ⅵ期的疗效观察

Therapeutic effect of vitrectomy and filling with C_3F_8 treatment for patients with diabetic retinopathy at stage Ⅵ

目的观察玻璃体切割联合惰性气体C3F8玻璃体内填充治疗糖尿病视网膜病变Ⅵ期的长期疗效。方法回顾性分析2007年至2010年于我院接受治疗的糖尿病视网膜病变Ⅵ期患者68例83眼的临床资料,患眼多发视网膜脱离,但脱离均呈局限性,每处视网膜脱离范围不超过5PD,且手术前后无视网膜裂孔或裂孔不发生于下方赤道部视网膜之前,患眼均行标准三切口经睫状体平坦部玻璃体切割视网膜激光光凝联合惰性气体(体积分数10%C3F8)填充术治疗,观察患者最佳矫正视力恢复情况、视网膜复位情况、OCT检测黄斑水肿状态的变化、术后荧光血管造影检查视网膜荧光渗漏情况。术后随访12～47个月,平均26个月。结果术后3个月所有患眼视网膜脱离均复位,视网膜荧光血管造影无或仅有少量荧光渗漏。至随访结束时,所有患眼术后视网膜仍在位,最佳矫正视力提高欁2行以上者58眼(69.9%),无变化者19眼(22.9%),降低者6眼(7.2%)。末次随访时荧光血管造影检查见所有患者视网膜均无或仅有少量荧光渗漏,与术后3个月相比较差异无统计学意义。术前可进行OCT检测的36眼中30眼(83.3%)黄斑水肿降低,2眼(5.6%)黄斑水肿无变化,4眼(11.1%)黄斑水肿加重;术后黄斑区视网膜厚度为(172±24)μm,较术前(284±17)μm显著降低(P<0.01)。结论玻璃体切割联合C3F8玻璃体内填充治疗Ⅵ期糖尿病视网膜病变疗效确切,同时也减轻了患者的经济负担,避免了患者长期面朝下体位及二次手术的痛苦,具有较好的远期效果。

Objective To observe the long-term results of vitrectomy and C3F8 gas filling in diabetic retinopathy at stage Ⅵ.Methods The clinical data of 68 patients（83 eyes） with diabetic retinopathy at stage Ⅵ were retrospectively analyzed during 2007 to 2010.Most eyes were retinal detachment,but the focus of infection was local,and the range was less than 5 PD.Before and after surgery,there was no retinal hole or the hole was not at anterior inferior ambitus.The disease eyes were by pars plana vitrectomy,retinal coagulation and volumn fraction of 10% perfluoropropane gas（C3F8） filling.The recovery of best corrected visual acuity,retinal detachment were observed.Changes of macular edema were detected by OCT,and the retinal fluorescence leakage was detected by FFA after surgery.All patients were followed up for 12 to 47 months,averaging in 26 months.Results The retinal detachment was recovered in all the 83 eyes within 3 months after the surgery.There was no or little leakage of FFA in those retinas.Till the end of the follow-up period,the retinal detachment was recovered in all the 83 eyes.Best corrected visual acuity improved for more than 2 lines in 58 eyes（69.9%）,remained unchange in 19 eyes（22.9%）,and decreased in 6 eyes（7.2%）.The leakage of FFA were not found or little,and there was no statistical significance with that at 3 months after the surgery.The macular edema was lowered in 30 eyes（83.3%） enable to take OCT examination,2 eyes（5.6%） were unchanged and 4 eyes（11.1%） were aggravated in the 36 eyes.After surgery,average retinal thickness at macular area was（172±24）μm,obviously lower than（284±17）μm before surgery（P0.01）.Conclusions There is certain therapeutic effects for vitrectomy with C3F8 gas filling in diabetic retinopathy at stage Ⅵ.It can lessen the economic burden of patients and avoid the body position of face-down for a long time,and with good long-term results.