进展型增生性糖尿病视网膜病变玻璃体切割手术的价值与意义

Evaluation of vitrectomy in advanced proliferative diabetic retinopathy

目的 了解有不同并发症的进展型增生性糖尿病视网膜病变眼进行玻璃体手术的结果。 方法 将患有 、 型糖尿病进展型增生性糖尿病视网膜病变的 314只眼分为玻璃体积血合并局限牵拉性视网膜脱离组 ;广泛纤维血管膜合并牵拉性视网膜脱离组 ;牵拉孔源混合性视网膜脱离组 ;玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组 ,分别进行回顾性分析。 结果 玻璃体积血合并局限牵拉性视网膜脱离组中 、 型糖尿病患者手术后获得 0 .1以上视力的分别占39.4%和 6 6 .7% ,广泛纤维血管膜合并牵拉性视网膜脱离组中 、 型糖尿病患者手术后获得 0 .1以上视力的分别占 31.6 %和 5 1.6 % ,牵拉孔源混合性视网膜脱离组手术后获得 0 .1以上视力者占 31.6 % ,玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组手术后获得 0 .1以上视力者占 6 2 .5 %。首要的术中并发症是医源性视网膜裂孔 ,术后视力丧失的主要原因包括新生血管性青光眼、视网膜脱离和视网膜中央动脉阻塞。 结论 玻璃体切割手术联合全视网膜光凝术 ,能有效地改善进展性糖尿病视网膜病变患者的视力。

Objective To evaluate improvement of visual acuity for advanced proliferative diabetic retinopathy eyes with different complications after vitrectomy. Methods Four groups of advanced proliferative diabetic retinopathy (APDR) in 314 eyes with diabetes type Ⅱ and type Ⅰ were analyzed retrospectively: vitreous hemorrhage with limited traction retinal detachment (VH), extensive fibrovascular membranes with traction retinal detachment (TD), combined rhegmatogenous and traction retinal detachment (CRT) and cataract with vitreous hemorrhage or and traction retinal detachment (CHD). Results 0.1 or better postoperative visual acuity was achieved in 59.5% of type Ⅱ and 66.7% of type Ⅰ in the VH group; 39.4% of type Ⅱ and 52.6% of type Ⅰ in the extensive TD group; 31.6% of the CRT group; 62.5% of the CHD group. The major intraoperative complication is iatrogenic retinal breaks. The causes of postoperative visual loss in present study included neovascular glaucoma (2.8% of type Ⅰ and 0.4% of type Ⅱ in aphakia, 25% of type Ⅱ in aphakia and 4.2% in pseudophakia), retinal detachment and CRAO. Conclusion The majority of APDR eyes obtained better visual improvement after vitrectomy and photocoagulation.