玻璃体切除术中全视网膜光凝治疗晚期增生性糖尿病视网膜病变

The effect of vitrectomy combined with full endocular panretinal photocoagulation in late proliferative diabetic retinopathy

目的 探讨玻璃体手术结合眼内激光一次性全视网膜光凝术治疗晚期增生性糖尿病视网膜病变 (PDR)的疗效。方法 晚期PDR患者 5 6例 (5 6只眼 ) ,其中牵引性视网膜脱离者 32例 (32只眼 )。所有患者均行玻璃体切除术和全视网膜光凝 ,约光凝 80 0～ 10 0 0个光斑。观察患者术前后视力、房水、晶状体、玻璃体、视网膜改变情况 ,分析患者术后荧光素眼底血管造影结果和并发症。结果 术后随访时间≥ 3个月 ,5 2只眼玻璃体腔和眼底均清晰 ,视网膜保持复位 ,未见新鲜出血、渗出灶及新生血管等。 32只眼术后行荧光素眼底血管造影检查 ,其中 2 8只眼未见无灌注区。术后视力提高者 5 2只眼。结论 眼内全视网膜光凝具有所需能量小、有效率高、并发症少、术后反复出血发生率低等优点。对于晚期PDR患者 ,在玻璃体切除术中行一次性全视网膜光凝 ,疗效满意 ,手术安全。

Objective To investigate the effect of vitrectomy combined with full endocular panretinal photocoagulation in patients with late stage of proliferative diabetic retinopathy (PDR). Methods Pars plana vitrectomy combined with full panretinal photocoagulation were undergone in 56 eyes (56 cases) with late stage of PDR, including 32 eyes with tractive retinal detachment. Preoperative and postoperative visual acuity, anterior segment by slit lamp and fundus examination by indirect ophthalmoscopy, as well as fluorescein angiography (FFA) were analyzed. Results Retina were reattached in 52 eyes. Vitreous hemorrhage, retinal bleeding, exudation and neovascular changes were not observed in these eyes. Non-irrigated areas were not found in 28/32 eyes in which FFA examination has been performed. Final visual acuity was improved in 52 eyes. Conclusion Full endocular panretinal photocoagulation with low energy is an effective and safe procedure with low rate of complications for the late stage of PDR.