玻璃体切除术治疗增殖型糖尿病性视网膜病变

Vitrectomy for treating proliferative diabetic retinopathy

目的 回顾性分析玻璃体切除术治疗增殖型糖尿病性视网膜病变 (proliferative diabetic retinopathy,PDR)的疗效。方法 对 34例 (40眼 ) PDR患者 (IV期 10眼 ,V期 14眼 ,VI期 16眼 )行常规扁平部三切口闭合式玻璃体切除术 ,同时根据病情分别行晶状体超声粉碎、晶状体切除、视网膜复位、眼内激光、硅油注入等。结果 随访 3～ 36 mo(平均 18.5 mo) ,术后脱盲率 47.5 0 % ,脱残率 15 .0 0 % ;术后 16眼角膜上皮愈合迟缓 (40 .0 0 % ) ;5眼发生新生血管性青光眼 (12 .5 0 % ) ;视网膜复位率 6 5 .2 2 % .结论 PDR合并严重玻璃体出血。牵引性视网膜脱离 ,应用玻璃体切除术可有效地清除玻璃体积血 ,缓解视网膜脱离。但因病情严重 ,手术难度大 ,术后视力恢复差 ,术后并发症多。

Objective To evaluate the effect of vitrectomy for treating proliferative diabetic retinopathy (PDR) retrospectively.Methods Thirty four cases(40 eyes,including 10 cases of stage IV,14 cases of stage V and 16 cases of stage VI of PDR) were operated on a standard threepoint vitrectomy.Lensectomy/ultrasonic fragmentation,retinal reattachment,endolaser treatment coagulation and silicone oil were applied when needed.Results The patients were followed up for 3～36 months(mean 18.5 months).The final visual acuity was 0.05 or better in 47.5%,and 0.3 or better in 15%.Forty percent(16 eyes)had slower recovery of corneal epithelia,12 5%(5 eyes) developed neovascular glaucoma and the rate of reattachment was 69.22%.Conclusions Vitrectomy is effective in PDR with severe vitreous hemorrhage and traction retinal detachment.It can clear hematocele and relieve traction of retina.However,the operation is of great difficulty because of the severe ocular disorder.Poor visual rehabilitation and many complications must be taken into account preoperatively.