增生性糖尿病视网膜病变玻璃体切除硅油或全氟丙烷填充术

Vitrectomy with silicone oil or perfluorinated propane tampomade for proliferative diabetic retinopathy

目的观察增生性糖尿病视网膜病变（PDR）玻璃体切除术后填充硅油或C3F8的临床效果。方法对本科2010年6月至2011年12月，PDR60例（77眼）行玻璃体切除手术。分硅油填充组和C3F8填充组，两组患者年龄、性别、病程的差异均无统计学意义（P〉0．05）。术后随访视力、眼压、视网膜、视神经变化。结果硅油填充组手术前后视力进行比较，差异有统计学意义（x^2=10．31，P〈0．05），C3F8填充组手术前后视力进行比较，差异有统计学意义（x^2=9．20，P〈0．05）。两组间手术后视力进行比较差异有统计学意义（x^2=9．01，P〈0．05）。硅油组与C3F8组术后眼压进行比较差异有统计学意义（Z=-3．50，P〈0．05）。硅油组41眼中视盘颜色苍白5眼（12．20％），视盘色淡3眼（7．32％），视网膜局部血管闭塞10眼（24．39％）；未发现视网膜再出血或脱离。C3F8填充组36眼术后气体全部吸收，视盘色淡3眼（8．33％），未发现有视盘色苍白或视网膜局部血管闭塞，视网膜再次出血5眼（13．88％），视网膜再次脱离2眼（5．55％）。结论PDR行玻璃体切除硅油填充术后效果良好，只有少数患者出现眼压难以控制，最终导致视功能损害。C3F8填充术后没有出现视网膜脱离及再出血者的视功能恢复要好于硅油填充组。所以PDR行玻璃体切除手术后应根据视网膜情况选择合适的玻璃体填充物，填充硅油的患者应在视网膜复位后尽早的取出眼内硅油，避免对视神经、视网膜造成不可逆性损害。

Objective To observe the clinical efficacy of vitrectomy with silicone oil or C3F8 tamponade for proliferative diabetic retinopathy （PDR）. Methods 77 eyes of 60 patients with PDR who underwent vitreetomy from June 2010 to Dec. 2011 in author＇ s hospital were divided into two groups： silicone oil filling group and C3F8 tamponade group. There were no statistically significant differences in patients, age, sex and course of the disease between two groups （P 〉 0.05） . The visual acuity, intraoeular pressure （IOP）, retina and optic nerve were observed after surgery. Results The differences in visual acuity between two groups before and after operation were statistically significant （x^2 = 9. 20, P 〈 0. 05 ; x^2 = 9. 01, P 〈 0.05 ）. The difference in IOP after surgery between two groups was statistically significant （ Z = - 3.50, P 〈 0.05）. Of 41eyes in silicone oil group, the optic disc was pale in 5 eyes （ 12.20% ）, the color of optic disc became light in 3 eyes （ 7.32% ） , local retinal vascular occlusion occurred in 10 eyes （24.39%） and no retinal hemorrhage or detachment was found. Of 36 eyes in C3F8 tamponade group the gas was absorbed in all eyes, the color of optic disc became light in 3 eyes （8.33%）, retinal hemorrhage was in 5 eyes （ 13.88% ） , retinal redetaehment occurred in 2 eyes （5.55%） and no pale optic disc or local retinal vascular occlusion was found. Conclusion Vitrectomy with silicone oil tamponade is effective on PDR with uncontrollable lOP in fewer patients which may cause damage to vision function. In C3F8 tamponade group, no retinal redetachment or hemorrhage occurs and the visual function is better than that in silicone oil tamponade group. The right vitreous filler should be chosen for the PDR patients according to the retinal condition. The silicone oil should be removed as soon as possible after retinal reattachment to avoid optic nerve and retinal damage.