增生型糖尿病视网膜病变玻璃体切割术后再出血的治疗和观察

Treatment and observation of postvitrectomy diabetic vitreous haemorrhage in patients with PDR

目的:探讨糖尿病视网膜病变玻璃体切割术后再出血(postvitrectomy diabetic vitreous haemorrhage,PDVH)的治疗方法及疗效。方法:回顾性分析2015-09/2017-06于我院行玻璃体切割术治疗后发生PDVH的PDR患者12例12眼,首先进行保守治疗,对出血量大、保守治疗效果差的患者进行手术治疗(前房冲洗、玻璃体腔灌洗、再次玻璃体切割术或联合白内障手术等),观察并分析患者治疗情况。结果:本组患者发生PDVH的时间为首次玻璃体切割术后1d～10mo(平均61.58±92.69d),其中早期PDVH患者8眼,晚期PDVH患者4眼。2眼患者行保守治疗2wk～1mo后出血吸收,10眼保守治疗无明显好转或眼内压(IOP)持续升高者再次行手术治疗,其中2眼行单纯前房冲洗术,8眼行玻璃体腔灌洗术(2眼联合白内障手术、1眼联合硅油注入术),7眼明确眼底情况后术中补充视网膜激光光凝。至末次随访,所有玻璃体腔再出血均吸收,9眼视力较治疗前提高。结论:多种原因可引起PDVH,可通过调控血糖、改进手术技巧、及时对症治疗等方法采取适当措施治疗,提高患者视力。

AIM： To discuss the treatment and to evaluate the therapeutic effect by reviewing a group of postvitrectomy diabetic vitreous haemorrhage（ PDVH） cases after vitrectomy for proliferative diabetic retinopathy（ PDR）.METHODS： Retrospective analysis of 12 cases of 12 PDR patients with PDVH in our hospital from September 2015 to June 2017. First,conservative treatment was performed and then surgical treatments were performed on patients with large amount of bleeding and poor effect of conservative treatment（ including anterior chamber flushing,vitreous lavage,vitrectomy,or combination of cataract surgery）. The patients were observed and analyzed during and after surgeries.RESULTS： The mean duration between the first surgery and PDVH ranged from 1 d to 10 mo（ mean 61. 58±92. 69 d）.The cases of early and late PDVH was 8 eyes and 4 eyes,respectively. Two eyes were treated with conservative treatment and the bleeding were absorbed after 2 wk-1 mo. Ten eyes without obvious improvement after treatment or intraocular pressure（ IOP） increased again received surgical treatment,in which 2 eyes were treated with simple anterior chamber flushing,8 eyes underwent vitreous lavage（ 2 eyes combined with cataract surgery,1 eyes combined with silicone oil injection）. Seven eyes received supplementary photocoagulation. Till the last follow-up,all vitreous haemorrhages resolved,and 9 eyes had better visual acuity. CONCLUSION： PDVH can be induced by various reasons and appropriate measures should be taken by regulating blood glucose,improving operative skills and timely symptomatic treatments to improve the visual acuity.