玻璃体切除术中联合改良眼内电凝止血治疗增生型糖尿病视网膜病变的短期效果观察

Short-term efficacy of combined modified intraocular electrocoagulation hemostasis in vitrectomy for the treatment of proliferative diabetic retinopathy

目的观察玻璃体切除术中联合改良眼内电凝止血治疗增生型糖尿病视网膜病变(PDR)的短期效果。方法回顾性病例系列研究。收集郑州大学第一附属医院2021年4月至2023年4月就诊的PDR伴玻璃体积血患者34例(34眼)的临床资料。患眼均行白内障超声乳化和人工晶状体植入联合玻璃体切除术。玻璃体切除术中关闭灌注3~5 s,形成一过性低眼压,定位出血点后恢复灌注,给予眼内电凝止血。随后进行广泛视网膜光凝。术后随访1个月。观察术后玻璃体积血发生率、术后最佳矫正视力(logMAR)和术后并发症情况。结果术后1 d出现玻璃体积血者1眼(2.94%,1/34),保守治疗7 d后积血吸收,随访未见其他并发症。术后3 d,5眼(14.70%,5/34)出现眼压升高(25~30 mmHg)(1 mmHg=0.133 kPa),经局部降眼压药物治疗后眼压恢复正常。术后1个月最佳矫正视力1.08±0.46优于术前1.43±0.56,差异有统计学意义(t=4.07,P<0.001)。结论玻璃体切除术中联合改良眼内电凝止血法治疗PDR伴玻璃体积血患者可有效提高视力并且术后再次玻璃体积血发生率降低。

ObjectiveTo observe the short-term efficacy of combined modified intraocular electrocoagulation hemostasis during vitrectomy for the treatment of proliferative diabetic retinopathy(PDR).MethodsA retrospective case series study was conducted.Clinical data of 34 patients(34 eyes)with PDR accompanied by vitreous hemorrhage in the First Affiliated Hospital of Zhengzhou University from Apr.2021 to Apr.2023 were collected.All eyes underwent phacoemulsification and intraocular lens implantation followed by vitrectomy.During vitrectomy,irrigation was temporarily stopped to induce transient low intraocular pressure(lasting 3-5 seconds).Then,the bleeding site was located before resuming perfusion.Finally,intraocular electrocoagulation was utilized to attain hemostasis.Following this,panretinal photocoagulation was performed.Patients were followed up for 1 month postoperatively.The incidence of postoperative vitreous hemorrhage,best corrected visual acuity(logMAR),and any postoperative complications were observed.ResultsAt 1 day after surgery,1 eye(2.94%,1/34)presented with vitreous hemorrhage,which was absorbed after 7 days of conservative treatment;no other complications were observed during the follow-up period.Within 3 days after surgery,5 eyes(14.70%,5/34)experienced elevated intraocular pressure(IOP)(25-30 mmHg)(1 mmHg=0.133 kPa),which was normalized after local IOP-lowering medication.At 1 month after surgery,best corrected visual acuity was significantly better at 1.08±0.46 compared to the preoperative level at 1.43±0.56(t=4.07,P<0.001).ConclusionVitrectomy combined with modified intraocular electrocoagulation hemostasis for the treatment of PDR accompanied by vitreous hemorrhage can improve visual acuity and reduce the incidence of postoperative vitreous hemorrhage.