玻璃体切除联合手术治疗糖尿病性视网膜病变临床观察

Clinical observation on vitrectomy combined surgery for the treatment of diabetic retinopathy

目的：观察玻璃体切除联合手术治疗糖尿病性视网膜病变（ DR）的效果。方法回顾性分析2010年2月至2013年2月在我院行玻璃体切除联合手术的71例（82眼）的病历资料。病例分为3组：第1组为单纯玻璃体积血组；第2组为玻璃体积血合并局限性视网膜脱离组，脱离未累及黄斑；第3组为玻璃体积血合并视网膜脱离累及黄斑组。全部病例术中完成广泛视网膜光凝及玻璃体内注射曲安奈德。对合并白内障影响手术视野者术中行晶状体超声乳化术。结果各组术后视力均有提高。第1组与第2组比较（χ2＝0．047， P＝0．828）差异无统计学意义；第1组与第3组比较（χ2＝7．108，P＝0．008），第2组与第3组比较（χ2＝8．861， P＝0．003），差异均有统计学意义。各组保留晶状体与摘出晶状体发生并发症的情况比较（χ2＝3．634， P＝0．057）差异无统计学意义。各组之间并发症的情况比较（χ2＝11．820，P＝0．003）差异有统计学意义。各组之间保留晶状体者发生并发症率比较（χ2＝6．002，P＝0．056）；及摘出晶状体者发生并发症率比较（χ2＝5．274，P＝0．072）差异均无统计学意义。结论在黄斑未明显受累时，术后视力恢复较好，并发症发生率较低，白内障手术不影响治疗效果，联合手术安全可靠。

Objective To observe the efficacy of vitrectomy combined surgery for diabetic retinopathy （ DR） .Methods The data of 82 eyes of 71 patients who underwent vitrectomy from February 2012 to February 2013 in our hospital were retrospectively analyzed .The patients were divided into 3 groups： the first group was pure vitreous hemorrhage , the second group was the vitreous hemorrhage combined with localized retinal detachment which was not involved in the macular and the third group was vitreous hemorrhage combined with retinal detachment involving the macular .Panretinal photocoagulation and intravitreal injection of triamcinolone acetionide were performed in all patients .The patients with cataract which affected the surgical field underwent phacoemulsification .Results The visual acuity improved in all of the three groups .There was no statistically significant difference between the first and second group （χ2 =0.047, P=0.828）.The difference was statistically significant between the first group and the third group （χ2 =7.108, P=0.008）.There was statistically significant difference between the second group and the third group （χ2 =8.861, P =0.003）.The difference in the complications among three groups was not statistically significant（χ2 =3.634, P=0.057）.The complications of the three groups was significantly different （χ2 =11.820,P=0.003）.The difference in the incidence of complications of patients whose lens were reserved among three groups was not statistically significant （χ2 =6.002, P=0.056）, and there was no statistically significant difference in the incidence of complications of patients with removal of lens among the three gronps（χ2 =5.274, P=0.072）.Conclusions The combined operation is safe and effective for the DR without involvement of macular , with the recovery of vision and fewer complications .The cataract surgery does not affect the therapeutic efficacy .