玻璃体切割术不同填充物对糖尿病玻璃体积血分析

Complications analysis on vitrectomy combined with different tampnoades for diabetic vitreous hemorrhage

目的:对比观察硅油(silicone oil,SO)、全氟丙烷(perfluoropropane,C3F8)、平衡盐液(balanced salt solution,BSS)三种不同玻璃体腔填充物对增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)并发玻璃体积血(vitreous hemorrhage,VH)的填充效果,探讨其在PDR玻璃体手术中的使用价值。方法:2008-06/2014-06在我院确诊为PDR并发VH,共60例74眼进行回顾性研究。术前反复检查眼底情况以确定术中玻璃体腔填充物。按填充物不同分成三组并对比患者手术前后视力、眼压及术后并发症的发生情况。结果:本研究三组术前视力差异有统计学意义(P<0.05)。其中术前视力SO组与C3F8组,C3F8组与BSS组比较,差异无统计学意义(P>0.05);SO组与BSS组的视力比较,差异有统计学意义(P<0.05)。术后视力三组比较,差异有统计学意义(P<0.05)。其中SO组与C3F8组比较,C3F8组与BSS组比较,差异无统计学意义(P>0.05);SO组与BSS组比较,差异有统计学意义(P<0.05)。术后视力较术前视力有明显改善(P<0.05)。三组术前眼压比较,差异无统计学意义(P>0.05)。三组术后眼压比较有统计学意义(P<0.05),其中各组间两两比较,差异均有统计学差异(P<0.05)。本研究中患者术后并发症总发生率为47%,其中SO发生率为50%,C3F8组为56%,BSS组为44%。结论:玻璃体手术可以明显改善糖尿病VH患者的术后视功能,是一种安全、有效的治疗方法。但术后由于填充自身理化性质及患者病情不同,仍存在一定并发症。

AIM：To evaluate and observe the efficacy of silicon oil （ SO ） , perfluoropropane （ C3 F8 ） and balanced salt solution （ BSS ） that can be used as tamponade during vitrectomy to treat proliferative diabetic retinopathy （ PDR） complicated with vitreous hemorrhage （ VH） . METHODS： Studied retrospectively on 74 eyes of 60 patients who underwent vitrectomy surgery with diabetic vitreous hemorrhage in our hospital during June 2008 and June 2014. Based on repeated prior examines on fundus details and the vitrectomy tamponades were chosen. All the patients had been followed up at least 3mo. Depending on different tamponades, the paitents were nonrandomized in three groups and contrasted as visual acuity, intraocular pressure （ IOP ） and complications respectively. RESULTS： There was statistically significant difference among these three groups in preoperative eyesight （ P〈0. 05 ）. Moreover, the preoperative eyesight was statistically different between SO and BSS （P〈0. 05）, and difference for the rest being not remarkable（P〉0. 05）. The difference being statistically difference in the postoperative vision among these three groups （ P 〈0. 05）. The further analysis showed that the paired-comparisons were statistically significant difference between SO and BSS （ P〈0. 05 ）, while the rest two groups of comparison were non-respectively（P〉0. 05）. The preoperative visual function was in contrast to the postoperative （P〈0. 05）. The IOP before surgery was not statistically significant difference（P〉0. 05）. However,the difference among three groups being statistically in the postoperative vision（P〈0. 05）, in addition,the difference existed in each group through pairwise comparison （ P〈0. 05） . The occurence rate of complications after surgery in this survey was 47%, the SO group was 50%, the C3 F8 was 56%, the BSS group was 44%. CONCLUSION： Vitrectomy is a safe and effective treatment that can help patients who have diabetic vitreous hemorrhage obtain better visual improvement. Because of the physicochemical properties and different conditions, there still has complications after surgery.