增殖期糖尿病视网膜病变玻璃体视网膜手术后玻璃体出血的临床分析

Clinical analyses of vitreous re-hemorrhage after vitreoretinal surgery in proliferative diabetic retinopathy

目的分析增殖期糖尿病视网膜病变（PDR）玻璃体视网膜手术后再出血原因，探讨预防及再处理方法。方法于2008年1月至2012年1月回顾性分析在广州军区武汉总医院眼科就诊的218例PDR患者246只眼行玻璃体视网膜手术后发生玻璃体再出血93只眼的临床资料。结果术后发生玻璃体再出血占该组玻璃体视网膜手术患者的37．8％（93／246），一周内最易出血，75．3％（70／93）出血发生在一月以内，出血自发清除率为73．1％，其中C3F8填充眼发生玻璃体再出血46只眼，占C3F8填充眼的47．9％，硅油眼发生玻璃体再出血者8只眼，占硅油填充眼的11．1％，空气填充眼发生玻璃体再出血12只眼，占空气填充眼的52．2％，灌注液填充眼发生玻璃体再出血者27只眼，占灌注液填充眼的49．1％。25只眼行再次手术治疗，视盘或视网膜新生血管纤维膜或血管残端处理不当9只眼，占36％，巩膜切口及前段新生纤维血管增生5只眼，占20％，视网膜激光光凝不足6只眼，占24％，视网膜静脉阻塞2只眼，占8％，原因不明3只眼，占12％。再出血眼出血吸收或再行手术治疗后视力提高81只眼，占87．1％，视力无变化7只眼，占7．5％，视力下降5只眼，占5．4％。结论术中彻底剥除视盘和视网膜新生血管膜，充分止血以及完善全视网膜激光光凝可有效预防和治疗玻璃体切割术后再出血。

Objective To analyze the reasons of vitreous re-hemorrhage after vitreoretinal sur- gery in proliferative diabetic retinopathy, to investigate the methods of prevention and treatment. Methods The clinical data of 218 patients （246 eyes） with PDR who had undergone vitreoretinal sur- gery were retrospectively analyzed. Results The occurrence of vitreous re-hemorrhage after vitreoreti- nal surgery was 37.8%. The most dangerous period of hemorrhage was within one week, and 75.3% of hemorrhageoccurs within a month. 73.1% hemorrhage was absorbed. In 93 eyes, C3F8 tamponade eyes occupied 47.9%, silicone oil tamponade eyes occupied 11.1%, air tamponade eyes occupied 52.2%, and infusion solution tamponade eyes occupied 49.1%. The reasons included residual neovas- cularization membrane or appropriately treated vascular stump on the surface of retina or （and） optic nerve （36%）, fibrovascular ingrowth at the sclera incision or （and） anterior ocular segment （20%）, in- sufficient photocoagulation on retina （24%）, retinal veinocclusion （8%）, and unexplained （12%）. After the retreatment the visual acuity increased in 87.1%, unchanged in 7.5%, and decreased in 5.45%. Conclusions Completely removal of residual neovascularization membrane on the optic nerve or （and） retina, electrocoagulation of the vessel stump and sufficient retinal photocoagulation are the effi- cient methods in preventing and treating re-hemorrhage after vitreoretinal surgery.