增殖性糖尿病视网膜病变玻璃体手术后再出血原因分析

Analysis of the cause of the re-hemorrhage in proliferative diabetic retinopathy after vitrectomy

目的 :探讨增殖性糖尿病视网膜病变 (proliferativediabeticretinopathy ,PDR)玻璃体视网膜手术后眼前段结构变化及再出血的原因。方法 :应用超声生物显微镜 (ultrasoundbiomicroscopic ,UBM )检查PDR玻璃体视网膜手术后再出血的病例17例 (17只眼 ) ,并与非糖尿病视网膜病变玻璃体手术 11例 (11只眼 )对比 ,了解眼前段结构变化的特点。结果 :①PDR玻璃体手术后再次玻璃体出血者 13例 (13只眼 )眼前段存在明显的纤维血管增生 ;4例 (4只眼 )无明显的纤维血管增生 ,仅表现为周边玻璃体混浊 ;②非糖尿病玻璃体手术无明显的纤维血管增生。结论 :眼前段纤维血管增生是PDR玻璃体手术后再次发生玻璃体出血的原因之一 ,纤维血管增生有可能与巩膜切口处理不当有关。UBM检查是较好的诊断方法 ,也是再手术方法选择的依据。

Objective:To investigate the changes of the anterior ocular segment structure and the causes of re-hemorrhage in the proliferative diabetic retinopathy(PDR) after vitrectomy.Method:17 patients(17 eyes)with PDR who had re-hemorrhage after vitrectomy and 11 patients(11 eyes) with non diabetic retinopathy after vitrectomy were examined with ultrasound biomicroscopy(UBM),in order to study and compare the characteristics of the changes of the anterior ocular segment structures in these two groups.Result:①In the PDR group,there existed obvious fibrovascular proliferation in 13 patients(13 eyes)and no obvious fibrovascular proliferarion but only peripheral vitreous opacity could be seen in 4 patients(4 eyes).②There was no obvious fibrovascular proliferation in the patients with non-diabetic retinopathy.Conclusion:The fibrovascular proliferation of the anterior ocular structure is one of the reasons of vitreous re-hemorrhage after vitrectomy in PDR.The fibrovascular proliferation may be related to the nonproper management of sclerotomy incision.UBM is a good method to diagnose the fibrovascular proliferation and it is also invaluable in deciding whether to operate again or not.