玻璃体手术联合光凝治疗增生型糖尿病视网膜病变

Combined vitrectomy and photocoagulation for the treatment of proliferative diabetic retinopathy

目的 :观察玻璃体手术联合光凝治疗增生型糖尿病视网膜病变 (PDR)的疗效。 方法 :对 1 0 6例PDR患者1 2 4只眼行玻璃体手术联合光凝治疗的疗效进行回顾性研究。 结果 :1 0 6例PDR患者发现糖尿病病史 0 .4～ 33(平均 7.2± 4 .6 )年 ,发现眼病史 30天～ 1 0年 (平均 1 .8± 0 .9)年。 1 2 4只眼中术前发现视网膜脱离 39只眼 ,有视网膜光凝治疗史 32只眼。术后视力提高 1 0 5只眼 (84 .7% ) ,无变化 1 1只眼 (8.9% ) ,下降 8只眼 (6 .5 % ) ,术后视力≥0 .1的 4 4只眼 (35 .5 % )。手术中联合白内障摘除 5 2只眼和人工晶状体植入 35只眼 ,合并视网膜脱离或有活动性出血行硅油充填 5 5只眼。术后有 4只眼发生新生血管性青光眼 ,3只眼视网膜再脱离。 结论 :大多数PDR患者经玻璃体手术联合光凝治疗后改善了视力 ,早期手术能减少手术并发症并获得较好的视力。术前有效的视网膜光凝能提高手术治愈率 。

Objectives:To observe the efficacy of vitrectomy and photocoagulation for the treatment of patients with proliferative diabetic retinopathy(PDR). Methods:Retrospective analysis of 124 eyes from 106 patients receiving vitrectomy and photocoagulation therapy for PDR. Results:The series included 124 eyes from 106 cases with diabetic history for 0.4～33(7.2±4.6) years and eye symptoms from 30 days to 10 (1.8±0.9) years. Retinal detachment(RD) was found in 39 eyes and retinal photocoagulation was performed in 32 eyes before vitrectomy. Visual improvement was achieved in 105 eyes(84.7%)with ≥0.1 in 44 eyes(35.5%). Visual acuity remained unchanged in 11 eyes (8.9%) and decreased in 8 eyes(6.5%). Cataract extraction was done in 52 eyes, of which 36 eyes with intraocular lens implantation. Silicone oil was injected in 55 eyes with retinal detachment or active bleeding. Neovascular glaucoma occurred in four eyes and retinal detachment recurred in three eyes after surgery. Conclusions:Vitrectomy and photocoagulation may improve the visual outcome in the majority of patients with PDR. Early operation should be recommended to reduce intraoperative complication and obtain better visual improvement. Sufficient retinal photocoagulation before operation may increase the operative success rate. Prompt laser coagulation after surgery can prevent progression of PDR.