玻璃体切割术治疗PDR合并黄斑区出血的手术时机

Operation timing of vitrectomy for treatment of proliferating diabetic retinopathy with macular hemorrhage

目的:探讨玻璃体切割术治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)合并黄斑区出血的手术时机。方法:回顾分析2009-03/2010-12行玻璃体切割术+全视网膜光凝术的PDR合并黄斑区出血患者62例62眼。其中38例38眼先行全视网膜光凝术,2mo后行玻璃体切割术。24例24眼直接行玻璃体切割术,术中行全视网膜光凝术。玻璃体切割术中根据有无合并虹膜虹变、视盘新生血管及有无晶状体等行眼内BSS或硅油充填,使视网膜得到良好复位。结果:病程<2mo组术后视力≥0.1者16眼(67%),病程≥2mo组术后视力≥0.1者9眼(24%)。两组比较差异有统计学意义(χ2=11.293,P=0.001)。病程<2mo组与病程≥2mo组术中眼内填充材料比较,差异有统计学意义(χ2=14.078,P<0.05)。结论:病程≥2mo的PDR合并黄斑区出血患者术中眼内填充材料宜采用硅油限制出血,使视网膜良好复位。在病变后2mo内手术治疗,术后可获得良好的视功能。

AIM：To investigate the operation timing of vitrectomy for proliferative diabetic retinopathy（PDR） with macular hemorrhage. METHODS：In this retrospective analysis study, 62 PDR patients （62 eyes） with macular hemorrhage were enrolled from March 2009 to December 2010. 38 cases （38 eyes） were treated with panretinal photocoagulation firstly, then underwent vitrectomy after 2 months. 24 cases （24 eyes） were treated with vitrectomy directly, and retinal photocoagulation was made at the same time. The patient were treated with BSS or silicone oil tamponade in vitrectomy surgery according to whether the merger of rubeosis iridis, optic disc neovascularization and lens intraocular, so the retina get a good reset. RESULTS：There were 16 （67%） eyes with course of disease 〈2 months and postoperative visual acuity ≥ 01. There were 9 （24%） eyes with course of disease≥ 2 months and postoperative visual acuity ≥ 0.1. The two groups difference was statistically significant （χ2=11293,P=0.001）. The difference of filler material was statistically significant （χ2 =14.078,P〈0.05）, comparing the course of disease 〈2 months group and ≥ 2 months group. CONCLUSION： PDR with macular hemorrhage patients should use silicone oil limiting hemorrhage to those whose course of disease ≥ 2 months, the retinal was reseted good. The patients who were treated in two months after the changes can get a good visual function.