玻璃体切除治疗增生性糖尿病视网膜病变继发早晚期玻璃体积血比较研究

Clinical study of vitrectomy for proliferative diabetic retinopathy combined with vitreous hemorrhage

目的比较早期和晚期玻璃体切除术治疗增生性糖尿病视网膜病变继发玻璃体积血的临床疗效及其安全性。方法回顾性非随机临床对照研究。于2014年6月至2015年6月在解放军武汉总医院全军眼科中心就诊的57例57只眼确诊为增生性糖尿病视网膜病变继发玻璃体积血患者，依据玻璃体积血病程≤3个月和〉3个月分为早期组29例（29只眼），晚期组28例（28只眼），两组患眼均由同一手术者行常规25G微创玻璃体视网膜手术。对比分析两组患者手术时间、玻璃体腔填充物，术后1周、1、3、6月最佳矫正视力（BCVA）。观察其疗效及安全性。结果早期组、晚期组手术操作的平均时间分别为60.52、91.61 min，手术时间比较具有统计学意义（t=-4.12，P=0.00）。早期组、晚期组行玻璃体腔硅油填充者分别为6.90%（2/29）、46.43%（13/28），硅油填充率具有统计学意义（χ2=-3.36，P=0.00）。两组术后6月BCVA均较术前提高，差异具有统计学意义（F=15.52，P=0.00；F=31.33，P=0.00），两组患眼之间术后1周、1、3、6月BCVA比较，差异均有统计学意义（t=-2.68，P=0.01；t=-4.20，P=0.00；t=-3.17，P=0.00；t=-2.83，P=0.01）。所有患者在手术中及术后随访均未见明显眼部或全身不良反应。结论采用玻璃体切除术治疗增生性糖尿病视网膜病变继发玻璃体积血是安全有效的。早期组较晚期组缩短手术时间，降低硅油填充率，术后视功能恢复较好。

ObjectiveTo compare the safety and effectiveness of vitrectomy for proliferative diabetic retinopathy combined with vitreous hemorrhage at early group and late group.MethodsAretrospective non-randomized controlled clinical studyreviewed 57 patients （57 eyes） diagnosedas proliferative diabetic retinopathy combined with vitreous hemorrhage.According to the time of vitreous hemorrhage,patients were divided into： less than 3 months group（29cases,29 eyes）,and more than 3 months group（28cases,28eyes）.All patients were done by 25G micro-invasive vitrectomy device. The operative time,use of silicone oil between the two groups were compared.Follow-up of these patients was 1 week,1 month,3 months and 6 months after the surgery,the BCVA was retrospectively observed.The changes of the BCVA were used to evaluate effectiveness before and after the surgery.ResultsThe average surgical time in the early group was 60.52 minutes,the late group was 91.61 minutes, the difference was statistically significant（t=-4.12,P=0.00）. Use of silicone oil of the early group was 6.90% （2/29） and the late group was 46.43% （13/28）,the difference was statistically significant （χ2=-3.36, P=0.00）, best corrected visual acuity （BCVA） of patients 6 months postoperative on both two groups were obviously improved comparing with preoperative visual acuity,the difference was statistically significant （F=15.52, P=0.00; F=31.33, P=0.00）.The BCVA in the early group was higher than that of the late group in 1 week,1 month,3 months and 6 months,the difference was statistically significant（t=-2.68, P=0.01; t=-4.20, P=0.00; t=-3.17, P=0.00; t=-2.83, P=0.01）. There were no ocular or systemic adverse events observed in all patients.ConclusionsVitrectomy is an efficacy and safety treatment for proliferative diabetic retinopathy combined with vitreous hemorrhage.The early group can decrease the operation time,reduce the incidence of use of silicone oil and help visual acuity rehabilitation.