PDR患者硅油填充术后视网膜功能评价

Evaluation of the functions of retina of diabetic patients receiving silicone oil influxing

目的:观察糖尿病视网膜病变患者硅油填充术后视网膜、视神经的改变,以了解增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者在行玻璃体切除硅油充填术后视神经、视网膜功能恢复情况;以及观察硅油填充术的安全性。方法:选择我科2010-06/2011-12确诊为PDR行玻璃体切除硅油填充术的患者30例41眼为观察组;糖尿病视网膜病变玻璃体切除术后全氟丙烷(C3F8)气体填充患者30例36眼为对照组,观察两组患者眼压、裂隙灯、最佳矫正视力(best corrected visual acuity,BCVA)、术后散瞳彩色眼底照相、视野检查等检查评价视网膜功能。结果:观察组30例41眼发现视神经色苍白15眼(37%),视神经色淡9眼(22%)。视网膜局部血管闭塞15眼(37%);对照组30例36眼术后3mo气体全部吸收,视神经色淡3眼(8%),未发现有视神经苍白及视网膜局部血管闭塞者,有统计学意义(P<0.05)。对术前与术后最后随访时的视力进行比较,观察组术后较术前视力提高23眼(56%),视力下降8眼(20%),视力不变10眼(24%);对照组术后视力较术前提高者33眼(92%),视力下降3眼(8%),两组视力比较有统计学意义(P<0.05)。术后7d,观察组平均眼压15.07±0.85mmHg,对照组17.84±1.86mmHg,两组比较有显著差异性(P<0.05),3wk后(随访时)随访眼压与术前的眼压进行比较无统计学意义。PDR行玻璃体切除手术的患者共60例77眼,术后3mo时26例36眼的视野检查发现:这部分患者呈管状视野样改变。结论:糖尿病视网膜病变患者硅油填充术后3mo,取出硅油后发现部分患者出现了视神经颜色变淡或苍白,视网膜局部血管闭塞,白鞘,增殖样改变,导致患者术眼视力、视野出现了不同程度损害,所以PDR行玻璃体切除后根据视网膜复位情况尽早释放硅油,以免造成视神经、视网膜的损害。

AIM ： To know the change of the retina and optic nerve for proliferative diabetic retinopathy （PDR） patients after silicone oil influxing, who have been performed with silicone oil influxing following vitrectomy, recover the functions of their retina and optic nerve, and to gain an insight into the safety of such operation. METHODS： Totally 30 patients, who were confirmed as PDR and performed with vitrectomy operation and silicone oil influxing during June 2010 to December 2011, were chosen as treat group; and 30 cases, who were performed with vitrectomy and C3 F8 influxing due to suffering from PDR, were chosen as control group. The patients in the two groups were observed for their intraocular pressure （ lOP）, best- corrected visual acuity （BCVA）, after surgery colored fundus photography, perimetry, etc. to examine and evaluate the retinal functions. ~ RESULTS： Among the 30 cases in observation group, 15 eyes were found pale optic nerve, 9 eyes were found with faint colored optic nerve, and 15 eyes were found with local blood vessel occlusion in the retina. Among the 30 cases in the control group, the gas was entirely absorbed after three months postoperation, 3 eyes were found with faint colored optic nerve, and no one was found with paint optic nerve and local blood vessel occlusion in the retina. Visual acuity. By comparing the visual acuity of the patients preoperation and postoperation in the latest follow-up visit, the visual acuity of the patient postoperation in the silicone oil influxing group is improved by 23 eyes than that preoperation, reduced by 8 eyes than that preoperation, while the visual acuity of 10 eyes keeps unchanged. postoperation in the C3 F8 group, the visual acuity is improved by 33 eyes, reduced by 3 eyes （8.33%, P〈 0.05 ）, which is of statistical significance. Using Goldmann tenometer to compare the average of the cases seven days postoperation and in the follow-up visit, the pressure in the silicone oil influxing group was 15.07_＋0.85mmHg, and that in the C3Fsgroup was 17.84＋ 1. 86 mmHg. The change postoperation was of significance difference （P〈0.05）. The pressure in one week＇s following visit was of no statistical significance. Visual field, among the 60 cases who were performed with vitrectomy due to suffering from PDR, the visual field examination of 26 cases three months after the operation was made. It was found that, their visual field was tubular change. CONCLUSION;Diabetic patients with silicone oil filling 3 months after surgery to remove the silicone oil found in some patients, color fades or pale optic local vascular occlusion of the retina, the white sheath, proliferating like change, As a result, the visual acuity and visual field of the patients showed impairment to different extent. Therefore, after they are operated with vitrectomy due to suffering from PDR, the silicone oil should be released as early as possible, depending on retinal restore so as to avoid impairment of optic nerve and retina.