增殖性糖尿病视网膜病变102例手术治疗的临床分析

Clinical analysis of 102 cases of proliferative diabetic retinopathy with surgical treatment

目的观察玻璃体切割术治疗增殖性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）的疗效及探讨影响手术效果的相关因素。方法选取2008年3月至2009年12月由同一术者完成玻璃体切割术治疗PDR患者102例（117只眼）的临床资料进行回顾性分析。结果（1）PDRIV期组36只眼（85．71％），PDRV期组27只眼（69．23％），PDR VI期组19只眼（52．78％）术后视力提高。（2）在PDRIV期组中，玻璃体积血时间小于2个月组术后视力改善率高于2～3个月组（x^2=4．621，P=0．032）；2～3个月组和大于3个月组的差异没有统计学意义（x^2=0，P=1．000）。（3）一次术后总的视网膜解剖在（复）位数为112只眼（95．73％），PDRIV期组41只眼（97．62％），PDRV期组38只眼（97．44％），PDRVI期组33只眼（91．67％）。（4）玻璃体再出血情况：术后保留灌注液组9只眼（17．31％）、C3F8填充组4只眼（13．33％）、硅油填充组6只眼（17．14％）发生玻璃体再出血，差异无统计学意义（x2=0．251，P=0．882）。术前行PRP组3只眼（6．52％），未行PRP组16只眼（22．54％）发生玻璃体再出血，差异有统计学意义（x^2=4．151，P=0．042）。结论玻璃体切割术能有效地改善增殖性糖尿病视网膜病变患者的视力；掌握恰当的手术时机对预后十分重要。

Objective To observe the surgical effect of vitrectomy for treating PDR and investi- gate the factors which influence the surgery. Methods The clinical data of 117 eyes （102 patients） who underwent vitrectomy by the same surgeon in our hospital were retrospectively studied from March, 2008 to December, 2009. Results Thirty-six eyes （85.71%） in PDR IV group, 27 eyes （69.23%） in PDR V group and 19 eyes （52.78%） in PDR VI group gained improvements in visual acuity after surgery. According to the duration of vitreous hemorrhage in PDR IV group, the postop- erative visual acuity improvement rate of less than 2 months group was higher than that of 2-3 months group （X^2=4.621, P =0.032）. There was no significant difference between 2-3 months group and more than 3 months group （X^2=0, P =1.000）. The total eyes with anatomically retinal attachment after one surgery were 112 （95.73%）, including 41 eyes （97.62%） in PDR IV group, 38 eyes （97.44%） in PDR V group and 33 eyes （91.67%） in PDR VI group. Recurrent vitreous hemorrhage： The 9 eyes （17.31%） in irrigation solution group, 4 eyes （13.33%） in C3F8 group and 6 eyes （17.14%） in silicon oil group presented recurrent vitreous hemorrhage. After vitrectomy, the distinction had no statistical significance （X^2=0.251, P =0.882）. The 3 eyes （6.52%） in preoperative PRP group and 16 eyes （22.54%） in non-preoperative PRP group encountered postoperative vitreous hemorrhage respectively, the distinction had statistical significance （X^2=4.151, P =0.042）. Conclusions The visual acuities of PDR patients can be well improved by pars plana vitrectomy. To master the appropriate opportunity of surgery is crucial for good prognosis.