25G玻璃体切割术治疗增生性糖尿病视网膜病变的长期预后分析被引量：10

Long-term Prognosis of 25 gauge Micro-incision Vitrectomy for Proliferative Diabetic Retinopathy in Patients with Type 1 Diabetes

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摘要目的研究25G微创玻璃体切割手术系统治疗1型糖尿病患者并发增生性糖尿病视网膜病变（PDR）后的长期治疗预后。方法系列病例回顾性研究。对90例（90只眼）行25G微创玻璃体切割手术系统治疗的1型糖尿病患者并发PDR从视力预后、视网膜复位、虹膜新生血管和新生血管性青光眼的发生等角度进行回顾性分析，数据的描述采用眼数和百分比，比较采用χ^2值检验。结果经过平均18．2月的随访观察后，一次术后总视网膜在位眼数80只眼（88．9％）。视力≥0．1所占比例由术前的16．7％（15只眼）提高到术后的47．8％（43只眼），有显著性差异（χ^2=19．94，P〈0．05）。9只眼术前存在虹膜新生血管的患者，6只眼（66．7％）在术后得到控制并完全消退，3只眼（100．0％）术前存在新生血管性青光眼的患者，在术后得到完全控制，眼压持续保持在正常范围。术前保留自身晶状体的81只眼中14只眼进行了晶状体超声乳化吸出联合玻璃体切割手术，其中2只眼在随访期内出现虹膜新生血管；另外67只眼中，6只眼在随访期内出现虹膜新生血管，两组相比较，差异无统计学意义（χ^2=0．37，P〉0．05）。术前存在视网膜脱离的56只眼中，16只眼给予保留灌注液处理，随访期内全部保持视网膜在位（100．0％）；16只眼给予惰性气体填充，随访期内14只眼（87．5％）保持视网膜在位；还有24只眼给予眼内硅油填充，其中17只眼（70．8％）保持视网膜在位。结论25微创玻璃体切割手术系统治疗1型糖尿病患者并发PDR的长期效果良好。 Objective To study the long-term effect of 25 gauge micro-incision vitrectomy for proliferative diabetic retinopathy （PDR） in patients with type 1 diabetes. Methods Retrospectively, we analyzed the cases with complete follow-up records.In a total, the visual outcome, retinal attached rate, the development of iris neovascularization and neovascular glaucoma of 90 cases （90 eyes） of PDR patients with type 1 diabetes who underwent 25 gauge micro-incision vitrectomy were retrospectively analysed. Results 16 eyes filled with an inert gas, follow-up period of 14 eyes （87.5%） in the retina.And 24 eyes filled with Silicone oil,among 17 eyes （70.8%） in the retina .During the follow-ups （mean 18.2 months）, the total rate of attached retina is 88.9% （90 eyes）. The rate of patients with visual acuity ≥0.1 increased from preoperative 16.7% （15 eyes） to postoperative 47.8% （43 eyes）（P 〈0.001）. In 9 eyes with preoperative iris neovascularization, the iris neovascularization were total controlled in 6 eyes （66.7%） after surgery. In 3 eyes with preoperative neovascular glaucoma, it was controlled in all eyes （100.0%） and the intraocular pressure was kept in normal level. In 56 eyes with preoperative retinal detachment, irrigation solution was kept in 16 eyes and retina kept attached in all the eyes （100.0%）; in 16 eyes with inactive gas as endo-tamponade, there were 14 eyes （87.5%） with attached retina during the whole follow-up; and in 24 eyes with silicone oil as endo-tamponade, there were 17 eyes （70.8%） with attached retina during the whole follow-up. Conclusions The long-term prognosis of PDR in patients with type 1 diabetes who were treated by 25 gauge micro-incision vitrectomy was good.

作者田蓓朱晓青魏文斌李哲清周波

机构地区首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室首都医科大学教学医院北京市石景山医院眼科

出处《中国实用眼科杂志》 2016年第8期841-844,共4页 Chinese Journal of Practical Ophthalmology

基金北京市医院管理局登峰人才培养计划项目（DFL20150201）

关键词增生性糖尿病视网膜病变玻璃体切除术 1型糖尿病 25G微创 Proliferative diabetic retinopathy Vitrectomy Type-1 diabetes 25 gauge Micro-incision

分类号 R587.2 [医药卫生—内分泌]

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