视网膜光凝联合玻璃体切除术治疗增生性糖尿病视网膜病变的有效性及安全性

Effectiveness and safety of retinal photocoagulation in combination with vitrectomy for proliferative diabetic retinopathy

目的探讨视网膜光凝(RP)联合玻璃体切除术治疗增生性糖尿病视网膜病变(PDR)的有效性及安全性。方法回顾性分析2010年3月至2014年3月行RP联合玻璃体切除术的79例(79眼)PDR患者的临床资料,观察患者术后视力改善及手术并发症情况。结果术后随访12个月,视力提高61眼(77.22%),视力不变15眼(18.99%),下降3眼(3.80%)。玻璃体切除术后1个月内有2眼发生眼压升高超过30 mm Hg,1眼出现新生血管性青光眼(NVG)、1眼出现视网膜脱离;3个月内有2例出现玻璃体再出血;12个月内有2眼发生硅油乳化继发青光眼。结论玻璃体切除术后造影能够有效治疗RP,既能避免过度光凝,又能防止光凝不足,在提高患者视力的同时,可减少并发症,提高安全性,值得临床推广。

Objective To investigate the effectiveness and safety of retinal photocoagulation（RP）in combination with vitrectomy in treatment of proliferative diabetic retinopathy（PDR）.Methods The clinical data of 79 patients （79 eyes）with PDR treated by RP and vitrectomy in our hospital during March 2010 to March 2014 were retrospectively analyzed.Results In a follow-up of 12 months after the operation,61 eyes （77.22%）improved their post-operative visual acuity ,15 eyes （18.99%）had the same vision and 3 eyes （3.80%）had deterioration.After vitrectomy of 1 month,2 eyes had the iop elevated over 30 mmHg,1 eye had neovascular glaucoma （NVG）,and 1 eye had retinal de-tachment.After vitrectomy of 3 months,2 eyes had fro vitreous hemorrhage again.After vitrectomy of 12 months,2 eyes had silicone oil emulsification occurred secondary glaucoma.Conclusion Angiography after vitrectomy can be targeted to treat RP.It can avoid excessive photocoagulation and can prevent photocoagulation insufficiently,improves in vision at the same time with few complications and high safety,is an effective method for PDR.