保留晶状体的玻璃体视网膜术治疗严重增殖型糖尿病视网膜病变观察

Clinical investigation on combination silicone oil removal with cataract surgery after vitreoretinal surgery reserved lens for severe proliferative diabetive retinopathy

目的分析Ⅵ期严重增殖型糖尿病视网膜病变（PDR）行保留晶状体的玻璃体视网膜手术（VRS）联合硅油填充术后，硅油取出时联合白内障超声乳化术的临床疗效及术后并发症。方法回顾性系列病例研究。收集2009年1月至2011年6月在天津眼科医院就诊的72例91只眼PDR患者均行23G或20G彻底的玻璃体切除、膜剥除、曲安奈德使用、气液交换或重水使用、眼内激光、巩膜外冷冻及硅油填充，所有手术保留晶状体。根据术后眼底恢复情况择期行硅油取出联合白内障超声乳化术。记录术前术后最佳矫正视力（BCVA）及术后并发症。结果所有患者平均年龄（54．35±7．20）岁，术后随访12～28个月，VRS和硅油取出联合白内障手术间隔平均时间（3．7±1．3）个月，视网膜完全复位88只眼，部分复位3只眼，复位率96．7％。59只眼（64．8％）术后BCVA提高，23只眼（25．3％）BCVA保持不变，另9只眼（9．9％）BCVA下降；术后BCVA≥0．1者54只眼（59．3％），0．02-0．1者19只眼（20．9％），≤0．02者18只眼（19．8％），术后2只眼BCVA达到0．8。术后并发糖尿病视神经病变32只眼（35．2％）；视网膜前膜14只眼（15．4％）；RD再发4只眼（4．4％）；继发性青光眼4只眼（4．4％）；一过性高眼压发生9只眼（9．9％），低眼压4只眼（4．4％），玻璃体再出血3只眼（3．3％）。结论严重PDR患者保留晶状体的VRS联合硅油填充术后，行硅油取出联合白内障超声乳化术安全有效。

Objective To evaluate long term visual outcome and complications of combination silicone oil removal with cataract surgery after vitreoretinal surgery reserved lens for severe proliferative diabetic retinopathy.Methord Retrospective series of clinical case studies about severe PDR.All 72cases 91 eyes of PDR patients were underwent 23G or 20G pars plana vitrectomy reserved lens,fibrovascular membranes peeling,triamcinolone acetonide use,fluid-air exchange or Perfluorodecalin use, interaocular laser, Sclera cryoablation and silicone oil tamponade, the lens is reserved in all eyes. When silicone oil was removed,phacoemulsification was combined at the same time.General material, preoperative and postoperative best corrected visual acuity and postoperative complications were recorded.Results The mean age of all patients was 54.35±7.20 yeas（range 39 to 70 years）and the post- operative follow-up time was 12 to 28 months.Time interval between VRS and silicone oil removal is 2.0-8.9 months,mean time 3.7±1.3 months;Anatomic retinal attachment was achieved in 88 eyes, Postoperatively, BCVA improved in 59 eyes （64.8%）, remained unchanged in 23 eyes （25.3%） and declined in 9 eyes（9.9%）.The postoperative complication incidence of diabetic optic neuropathy,Epiretinal membrane, recurrent RD, Secondary glaucoma, transient intraocular pressure rise, hypotony and vitreous hemorrhage was 35.2%, 15.4%,4.4%,4.4%, 9.9%,4.4% and 3.3% respectively.Conclusions In patients with silicone oil tamponade after vitrectomy reserved lens for severe proliferative diabetic retinopathy,silicone oil removal combined with phacoemulsification is safe and effective.