摘要
目的研究增生性糖尿病视网膜病变(PDR)合并纤维血管膜患者行膜分割和膜清除两种手术方法的临床效果。方法对1996-2000年行玻璃体手术的276例(296只眼)PDR患者的连续临床资料进行回顾性分析。严格选择术后随访时间超过4个月者,硅油填充眼必须是在取出硅油后超过3个月者。所有患者的视网膜上均有纤维血管膜,201只眼合并不同程度的玻璃体积血,101只眼合并不同程度的牵拉性视网膜脱离。在玻璃体手术中,110只眼采用膜分割方法,186只眼采用膜清除方法。比较“膜分割”与“膜清除”两组患者术中医源性视网膜裂孔、术后玻璃体积血及术后视力>0.1的发生率。并对膜分割和膜清除组中采用同一种填充物眼的疗效进行比较。结果两组患者的性别、年龄及病变分型比较,差异无显著意义(P>0.05)。膜分割组患者视网膜裂孔发生率(35.5％)低于膜清除组(54.3％),而术后视网膜再出血率和术后视力的改善率在两种手术方法间差异无显著意义(P>0.05)。结论膜分割组患者术中形成视网膜裂孔的风险小,术后出血的发生率稍低于膜清除组;两组患者术后视力改善率差异无显著意义(P>0.05)。建议初学者行PDR玻璃体手术时应从膜分割起步。(中华眼科杂志,2004,40:439-442)
Objective Compare membrane dissections and en bloc membranectomy in vitrectomy of proliferative diabetic retinopathy. Methods Retrospective comparative ( non-randomized) interventional study. 296 eyes of 276 patients with fibrovascular proliferation in diabetic retinopathy performed by vitrectomy from 1996 - 2000 were analyzed. 201 eyes complicated with vitreous hemorrhages in different severity , 110 eye with traction retinal detachment. We used membrane dissection in 110 eyes and en bloc excision in 186 eyes. Follow up time required more than 4 months, for the silicone oil temponade eyes required 3 months after silicone oil removal. The iatrogenic holes, postoperative hemorrhages, rubeosis iridis and visual improvement were compared in the same intraocular temponade for membrane dissections and en bloc excision, as well as visual acuity > 0. 1. Results There is no statistic significant difference in age, sex and type of fibrovascular proliferations for both groups. Membrane dissection techniques showed a lower incidence of iatrogenic breaks (35.5%) than that in en bloc membranectomy techniques, no significant difference in postoperative vitreous hemorrhages and visual improvement for both techniques. Conclusion Both techniques showed no difference to visual results and postoperative complications, but membrane dissection techniques can decrease the formation of iatrogenic breaks. (Chin J Ophthalmol, 2004, 40: 439-442)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2004年第7期439-442,共4页
Chinese Journal of Ophthalmology
