联合手术治疗晶状体轻度混浊的糖尿病视网膜病变的临床疗效观察

Clinical efficacy of combination surgery on patients with diabetic retinopathy complicated with mild lens opacity

目的比较玻璃体切除术联合超声乳化白内障吸除术和人工晶体植入术与单纯玻璃体切除术对晶状体轻度混浊的糖尿病视网膜病变(DR)患者的临床疗效。方法 104例(121眼)晶状体轻度混浊的DR患者,其中行单纯玻璃体切除术(单纯组)共48例54眼,行玻璃体切除术联合超声乳化白内障吸除术、人工晶体植入术(联合组)共56例67眼。随访3年,比较两组患者的视力恢复情况、视网膜病变的进展及术后并发症等。结果 (1)两组患者不同时间点的最小分辨角的对数(log MAR)比较,差异有统计学意义(P<0.05),2组log MAR总体均呈下降趋势;(2)两组患者不同时间点的早期糖尿病视网膜病变治疗研究评分变化比较,差异有统计学意义(P<0.05),两组的患者均在术后6个月时视力改善较明显,但单纯组在术后1年左右视力出现了下降趋势,随后又逐渐改善,而联合组则在术后6个月之后一直保持稳定,且逐渐改善;(3)术后3年内单纯组、联合组分别有43眼(79.6%)、7眼(10.4%)发展为白内障,联合组术后白内障发生率明显低于单纯组(P<0.05);(4)两组患者手术后DR进展和并发症发生率比较,差异无统计学意义(P>0.05)。结论对于晶状体轻度混浊的DR患者,玻璃体切除联合超声乳化白内障吸除术和人工晶体植入术是安全可靠的手术方式。

Objective To compare the clinical efficacy between vitrectomy alone and vitrectomy combined with phacoemulsification and intraocular lens implantation on patients with diabetic retinopathy（ DR） complicated with mild lens opacity. Methods A total of 104patients（ 121 eyes） with DR complicated with mild lens opacity were enrolled,including 48 patients（ 54 eyes） receiving vitrectomy alone（ simplex group） and 56 patients（ 67 eyes） receiving vitrectomy combined with phacoemulsification and intraocular lens implantation（ combination group）. During 3-year follow-up,the visual recovery,progression of retinopathy and postoperative complications were compared between two groups. Results 1 There was statistical difference in the logarithm of the mininum angle of resolution（ log MAR） of two groups among different time points（ P 〈 0. 05）,and the overall log MAR in both groups tended to decrease. 2 There was statistical difference in the early treatment diabetic retinopathy study score of two group among different time points（ P 〈 0. 05）. The visions of patients in both groups improved significantly six months after surgery. The visions of patients in the simplex group decreased one year after surgery but improved subsequently. However,the visions of patients in the combination group kept stable six months after surgery and improved gradually. 3 During 3-year of postoperation,43 eyes（ 79. 6%） and 7 eyes（ 10. 4%） developed into cataract in the simplex group and combination group respectively,and the incidence of cataract in the combination group was significantly lower than that in the simplex group（ P 〈 0. 05）. 4 There was no statistical difference in the progress of DR or incidence of complications between two groups after surgery（ P 〉 0. 05）. Conclusion For patients with DR complicated with mild lens opacity,vitrectomy combined with phacoemulsification and intraocular lens implantation is a safety and reliable surgical approach.