增生性糖尿病视网膜病变患者玻璃体手术中植入人工晶状体的临床效果观察

Simultaneous intraocular lens implantation during vitreous surgery for treatment of proliferative diabetic retinopathy

目的 探讨白内障合并增生性糖尿病视网膜病变 (proliferativediabeticretinopathy ,PDR)患者的玻璃体手术中 ,同期行白内障摘除和后房型人工晶状体 (intraocularlens,IOL)植入术的临床效果。方法 回顾性分析 1997年 2月至 2 0 0 1年 10月本院连续住院 ,并经同一手术医师治疗的增生性糖尿病视网膜病变患者 37例 (44只眼 )。其中男 12例 ,女 2 5例 ;13只右眼 ,17只左眼 ,7例双眼 ;年龄36～ 76岁 ,平均 5 7岁 ;患有糖尿病史 1～ 30年 ,眼病史 4 0d至 10年。手术中经平坦部做白内障摘除术 ,保留前囊并吸刮上皮层。在完成玻璃体手术和眼内激光光凝后 ,做角巩膜缘切口 ,将人工晶状体植入前囊上 ,然后环形切除前囊中央直径 5mm组织。术前患者视力为光感、眼前手动和指数者分别为 5、14和 11只眼 ,0 0 2者 6只眼 ,0 1～ 0 2者 8只眼。结果 术后随访 3个月至 4 5年 ,平均 (16±13)个月。患者视力改善 4 1只眼 ,不变 2只眼 ,下降 1只眼 ;其中 0 1～ 1 0者 35只眼 ,占 79 5 %。术后视力低下者多伴有明显的黄斑水肿、硬性渗出或视网膜广泛缺血。术后 2～ 5d ,有 6只眼发生轻度角膜水肿 ;术后 5个月 2只眼分别发生角膜溃疡和新生血管性青光眼。结论 在增生性糖尿病视网膜病变患者的玻璃体手术中 。

Objective To evaluate the efficacy of cataract extraction and simultaneous intraocular lens (IOL) implantation during vitreous surgery for treatment of a series of patients with proliferative diabetic retinopathy (PDR) and cataract. Methods A consecutive series of PDR treated with vitrectomy and simultaneous IOL implantation during February 1997 and October 2001 was retrospectively analyzed. Results The series included 37 cases (12 males and 25 females) 44 eyes (OD 13; OS 17 and OU 7) with diabetic history for 1 30 years and eye symptoms for 40 days to 10 years. Surgical techniques included lensectomy or phacofragmentation via the pars plana. The anterior capsule was preserved and the epithelium was suctioned and scraped off. After vitreous surgery and endolaser, IOL was inserted via the corneoscleral incision on the anterior capsule, of which the center area 5 mm in diameter was cut. The patients was followed up for 3 months to 4 5 years, mean (16±13) months. Visual acuity was light perception, hand motion, finger count, 0 02, and 0 1 0 2 in 5, 14, 11, 6, and 8 (18 2%) eyes, respectively before operation. Postoperatively, visual improvement was achieved in 41 eyes with 0 1 1 0 in 35 eyes (79 5%). Visual acuity remained unchanged in 2 eyes and decreased in one eye. Eyes with lower vision were associated with marked macular edema, hard exudates and severe ischemia. Six eyes had mild corneal edema 2～5 days after operation. Corneal ulcer or neovascular glaucoma occurred in 2 eyes 5 months after surgery. Conclusion Cataract extraction and simultaneous IOL implantation during vitreous surgery for PDR may improve the visual outcome in the majority of selected eyes without significant complications.