糖尿病性视网膜病变(Ⅵ期)行玻璃体切割术中激光量对术后疗效的影响

Effect of points of panretinal photocoagulation in vitrectomy for proliferative diabetic retinopathy( Ⅵ)

目的评价糖尿病性视网膜病变(Ⅵ期)玻璃体切割术中光凝量对术后疗效的影响。方法选取确诊为糖尿病性视网膜病变(Ⅵ期),须行玻璃体切割手术56例患者58只眼,术前5日均行抗VEGF药物雷珠单抗玻璃体腔注射,使用25G玻璃体切割技术,术中使用曲安奈德,除外术前行激光光凝术,按照统计的术中有效激光点数分组,以800点以下、800～1500点、1500点以上分为A、B、C三组。分别从短期和长期的视力、眼压、眼内再出血、视网膜新生血管是否消退等方面研究。结果 (1)术后视力提高47眼(81. 03%),其中A组14眼(73. 68%),B组19眼(86. 36%),C组14眼(82. 35%),三组间术后视力提高无统计学差异(P=0. 642);(2)术后(1周内)高眼压共30眼(51. 72%),其中A组9眼(47. 37%),B组13眼(59. 10%),C组8眼(47. 06%),A组、B组和C组间术后(1周内)眼压无统计学差异(P=0. 677);术后随访1个月以上,高眼压共8眼(13. 79%),其中A组6眼(31. 58%),B组1眼(4. 55%),C组1眼(5. 88%),三组比较,激光量不同与眼压存在统计学差异(P=0. 043);(3)术后(1周内)眼内再出血共13眼(22. 41%),其中A组5眼(23. 32%),B组4眼(18. 18%),C组4眼(23. 53%),三组间比较无统计学差异(P=0. 857);术后3周以上,共6眼(10. 34%)发生眼内再出血,其中A组5眼(26. 31%),B组1眼(4. 55%),C组未发现眼内再出血,三组比较存在统计学差异(P=0. 020)。结论适当的光凝量降低了玻璃体切割术后眼内再出血的发生率,能有效控制眼压平稳。激光量不足增加了眼底再出血和眼压控制不良的风险。全视网膜激光光凝术与术后视力提高无明显联系。

Objective To analyze the effect of points of panretinal photocoagulation （PRP） in 25 G vitrectomy for proliferative diabetic retinopathy. Methods The sample size of 58 eyes undergone 25 G vitrectomy for proliferative diabetic retinopathy （ Ⅵ） with ranibizumab injection were divided into three groups according to points of PRP, including group A （ 〈 800 points）, group B （800 - 1500 points） and group C （ 〉 1 500 points）. The relation between PRP and the corrected visual acuity, intraocular pressure （IOP）, recurrent vitreous hemorrhage, retinal nonperfusion and other complications were analysed. Results （1）Postoperative visual acuity improved in 47 eyes, including 14 eyes in group A（73.68% ）, 19 eyes in group B（86. 36% ） and ld eyes in group C（82. 35% ）. There was no statistical difference among the three groups （P = 0. 642）. （2）A total of 30 eyes werewith high intraocular pressure after vitrectomy （within 1 week） （51.72%） ,including 9 eyes in group A（47.37% ）, 13 eyes in group B （59.10%） and 8 eyes in group C （47.06%）. There were no significant differences in intraocular pressure （IOP） among group A, group B, and group C （within 1 week） （P=0. 677）. Postoperative follow-up for more than 1 month showed high intraocular pressure in 8 eyes （ 13.79% ）, including 6 eyes in group A（31.58% ）, 1 eye in group B（4.55% ）, and 1 eye in group C（5.88% ）. In the three groups, there was statistical difference between laser quantity and intraocular pressure （ P = 0. 043 ）. （3）Intraocular rebleedingoccurred after vitrectomy in 13 eyes （within 1 week） （22. 41% ）, including 5 eyes in group A（23.32% ）, 4 eyes in group B（ 18.18% ）, 4 eyes in group C（23.53% ）. There was no statistical difference among the three groups （P = 0. 857 ）. More than 3 weeks after vitrectomy, intraocular rebleeding occurred in 6 eyes （10. 34% ） , including 5 eyes in group A（26.31% ）, 1 eye in group B（4.55% ）, and no eye in group C. There was statistical difference among the three groups （P = 0. 020）. Conclusion Proper photocoagulation reduces the incidence of intraocular rebleeding after vitrectomy and can effectively control intraocular pressure. Insufficient laser volume increases the risk of rebleeding in the fundus and poor intraocular pressure control. Panretinal photocoagulation （PRP） is not associated with postoperative visual acuity.