增生性糖尿病性视网膜病变合并牵引的孔源性视网膜脱离手术效果观察

Observation on the efficacy of the surgery for proliferative diabetic retinopathy with traction-rhegmatogenous retinal detachment

目的观察增生性糖尿病性视网膜病变(PDR)牵引的孔源性视网膜脱离的手术方法及手术效果。方法回顾性病例系列研究。收集聊城爱尔眼科医院2019年12月至2020年12月的30例(30眼)PDR合并牵引的孔源性视网膜脱离的临床资料,均采用标准的三通道微创玻璃体切除术,在高清的全视网膜镜及氙光照明系统下,完全切除玻璃体及其积血后以黏弹剂辅助单手剥膜或吊灯下双手剥膜等技术将PDR膜分割分层剥除,切开或切除僵硬及挛缩的视网膜,对严重的前部增生性玻璃体视网膜病变行周边视网膜的360°切开或切除及广泛视网膜光凝;术后随访6~12个月,观察视力及眼底情况。结果患者的纤维血管膜均采用了经典的分割及分层处理,14眼行部分视网膜切开或切除;2眼行周边视网膜的360°切开或切除;均填充了硅油。术后24眼(80.00%)视力改善。结论玻璃体切除术中应用黏弹剂辅助单手剥膜或吊顶灯双手剥膜技术治疗合并PDR牵引的孔源性视网膜脱离效果良好。

Objective To observe the surgical skills and efficacy of proliferative diabetic retinopathy(PDR)with traction-rhegmatogenous retinal detachment(RRD).Methods This was a retrospective case series study.The clinical data of 30 eyes of 30 patients with PDR complicated with traction-rhegmatogenus retinal detachment were collected from Dec.2019 to Dec.2020 in Liaocheng Aier Eye Hospital.All patients were treated with standard three-channel minimally invasive vitrectomy.The PDR membrane was dissected and peeled off with viscoelastic agent or double-handed stripping under the chandelier after complete vitrectomy;the rigid and contracted retina was excised.The peripheral retinal 360-degree incision or excision and panretinal photocoagulation were performed in patients with severe anterior proliferative vitreoretinopathy.The follow-up time was 6-12 months.The visual acuity and fundus were observed.Results The fibrovascular membranes of all patients were divided and stratified,14 eyes underwent partial retinotomy or excision,2 eyes underwent 360 degree retinotomy or excision of peripheral retinas,and all eyes received silicone oil tamponade.Postoperative visual acuity was improved in 24 eyes.Conclusion The application of single-handed membrane stripping assisted by viscoelastic agent or double-handed membrane stripping technology under ceiling lamp in vitrectomy for the treatment of rhegmatogenous retinal detachment with PDR traction is effective.