增生性糖尿病视网膜病变玻璃体切割术后再出血(PDVH)的原因及疗效分析

Tanalysis of the causes and efficacy of rebleeding(PDVH) after vitrectomy in patients with proliferative diabetic retinopathy

目的观探讨增生性糖尿病视网膜病变(PDR)玻璃体切割术后眼内再出血的发生原因、发生时间及治疗预后,指导手术注意事项。方法收集2015年12月-2018年12月因PDVH于中国科学技术大学附属第一医院眼科行玻璃体腔灌洗术的患者25例(25眼),对临床资料进行回顾性分析,对再出血的发生原因、发生时间及术前术后视力等进行重点观察分析,并统计我院PDVH发生率。结果在25例(25眼)PDVH患者中,首次玻璃体切割术后玻璃体再出血时间约为7-260天,平均为92.24±62.98天。再出血原因为视盘新生血管有10例(40%),视网膜表面新生血管膜剥除不彻底及血管残端处理不当有6例(24%),视网膜光凝不充分有5例(20%),巩膜切口纤维血管向内生长有4例(16%)。我院PDVH发生率约为2.7%。结论玻璃体切割术是治疗PDR的一种安全有效的方法。明确患者再出血的原因后进行针对性治疗,有助于改善患者视功能。

Objective To investigate the cause,time and prognosis of intraocular rebleeding after vitrectomy for proliferative diabetic retinopathy(PDR).Methods The clinical data of 25 patients(25 eyes) underwent vitreous cavity lavage due to PDVH in the First Affiliated Hospital of the University of Science and Technology of China from December 2015 to 2018 were retrospectively analyzed,the causes,time,preoperative and postoperative visual acuity of rebleeding were observed and analyzed,and the incidence of PDVH in our hospital was calculated.Results In 25 patients(25 eyes) with PDVH,the vitreous bleeding time after the first vitrectomy was about 7-260 days,with an average of 92.24±62.98 days.Rebleeding was caused by 10 cases(40%) of optic disc neovascularization,6 cases(24%) of incomplete neovascularization of retinal surface and improper treatment of vascular stump,5 cases(20%) of inadequate retinal photocoagulation,and 4 cases(16%) of inward growth of fibrous vessels in scleral incision.The incidence of PDVH in our hospital was about 2.7%.Conclusion Vitrectomy is a safe and effective method to treat PDR.It is beneficial to improve the visual function of patients to carry out targeted treatment after clarifying the cause of rebleeding.