伴肾功能不全的Ⅵ期糖尿病视网膜病变前后节联合手术后前房渗出膜对疗效的影响

Effect of proliferative membrane in the anterior chamber on the treatment outcome of phacoemulsification combined with vitrectomy among patients with proliferative diabetic retinopathy and renal insufficiency

目的观察前后节联合手术后前房纤维渗出膜对伴肾功能不全的Ⅵ期糖尿病视网膜病变(PDR)疗效的影响。方法对42例(50只眼)伴肾功能不全的Ⅵ期PDR患者行23G微创玻璃体切除+白内障超声乳化吸除+视网膜前膜剥膜+全视网膜光凝术+硅油填充术,术后根据有无前房前纤维膜,分为两组,观察两组患者术后的最佳矫正视力(BCVA)、眼压、虹膜红变发生情况、睫状体脱离和周边部脉络膜脱离情况。结果根据前后节联合术后两组患者眼压分别为(10.23±3.06)mmHg和(15.67±4.28)mmHg,差异明显(t=3.99,P<0.01);对两组患者术后BCVA、虹膜红变发生情况睫状体脱离和周边部脉络膜脱离情况的构成进行比较,无纤维膜组患者疗效好于有纤维膜组,差异均有统计学意义(χ^2=14.18、7.24、5.23,P<0.05、<0.01、<0.05)。结论前后节联合手术治疗伴肾功能不全的Ⅵ期糖尿病视网膜病变术后出现前房纤维膜使术眼发生低眼压、睫状体脱离和周边部视网膜脱离的情况明显增加,严重影响患者视功能的恢复。

Objective To assess the effect of proliferative membrane in the anterior chamber on the treatment outcome of phacoemulsification combined with vitrectomy among patients with proliferative diabetic retinopathy and renal insufficiency.Methods Forty-two patients(50 eyes) with proliferative diabetic retinopathy(phase Ⅵ) and renal insufficiency were treated by 23 G vitrectomy, phacoemulsification, proliferative membrane peeling, panretinal photocoagulation and intravitreal injection of silicone oil. The study subjects were divided into two groups according to the presence of proliferative membrane in the anterior chamber. The visual acuity, intraocular pressure, development of rubeosis iridis, ciliary detachment and retinal detachment after the surgery were assessed. Results The intraocular pressure after the surgery was 10.34±3.06 and 15.67±4.28 mmHg,respectively, with significant difference(t=3.99,P<0.01). The best-corrected visual acuity, development of rubeosis iridis, ciliary detachment and peripherial choroidal detachment were worse in the group with proliferative membrane than the group without, and the difference was statistically significant(χ^2=14.18,7.24 and 5.23;P<0.05, <0.01 and<0.05). Conclusions For patients with proliferative diabetic retinopathy and renal insufficiency, the risk of low intraocular pressure, ciliary detachment and peripheral retinal detachment are higher in eyes with proliferative membrane in the anterior chamber after phacoemulsification combined with vitrectomy, posing a negative effect on the recovery of patients’ visual function.