23-G微创玻璃体切除术联合超声乳化术治疗早期PDR合并玻璃体积血

Clinical effects of 23-G micro-invasive with vitrectomy and phacoemulcification for early proliferative diabetic retinopathy and vitreous hemorrhage

目的：探讨23-G微创玻璃体切除术联合超声乳化术治疗早期增生性糖尿病视网膜病变（ proliferative diabetic retinopathy ，PDR）合并玻璃体积血的临床疗效及其并发症的问题。 方法：回顾性分析2011-01／2013-01因早期增生性糖尿病视网膜病变合并玻璃体积血在我院接受23-G微创玻璃体切除联合超声乳化白内障摘除人工晶状体植入术者48例48眼，记录术前和术后1 mp最佳矫正视力，观察眼压、炎症反应，人工晶状体位置以及眼底病情的变化，随访时间4～18 mo。 结果：术后1 mo最佳矫正视力，视力提高43眼（90％），视力≥0．12者36眼（75％），视力≥0．3者15眼（31％），手术前后视力差异有显著性（ P＝0．00）。术后有6眼（13％）低眼压，5眼（10％）发生脉络膜脱离，13眼（27％）出现前房炎症反应，16眼（33％）术后早期高眼压，10眼（21％）术后玻璃体腔出血，术后玻璃体视网膜增生性病变、视网膜脱离、虹膜红变及新生血管性青光眼均未发生。 结论：23-G微创玻璃体切除术联合超声乳化术治疗早期增生性糖尿病视网膜病变是安全有效的。

AIM：To investigate the surgical therapeutic effects and complications of 23-gauge （23-G） vitrectomy combined with phacoemulcification for early proliferative diabetic retinopathy （ PDR） and vitreous hemorrhage. METHODS： The 23 -G micro -invasive vitrectomy combined with phacoemulcification and intraocular lens implantation were done in 48 patients （ 48 eyes ） from Jan.2011 to Jan.2013.Best corrected visual acuity was recorded before or after operation 1mo.All patients were followed up for 4-18mo to observe the eye pressure, inflammatory reaction, intraocular lens location, and the changes of fundus conditions. RESULTS： After 1mo operation, best corrected visual acuity improved 43 eyes （ 90%） , the visual acuity of 36 eyes （75%） ≥0.12, 15 eyes （31%） ≥0.3, visual acuity in preoperation or postoperation was different significantly （P=0.00）.There were 6 eyes （13%） with hypotony, 5 eyes （ 10%） with choroidal detachment, 13 eyes （ 27%） with inflammation in anterior chamber, 16 eyes （33%） with increased intraocular pressure, and 10 eyes （ 21%） with vitreous hemorrhage after operation. However, there were no vitreous retinal hyperplastic lesions, retinal detachment, iris rubeosis, and neovascular glaucoma postoperatively. CONCLUSION： The 23-G micro-invasive vitrectomy combined with phacoemulcification and for early proliferative diabetic retinopathy is safe and effective.