摘要
目的：探讨糖尿病视网膜病变（DR）玻璃体切割手术后玻璃体积血的原因，处理措施以及对预后的影响。方法：回顾性分析98例DRIV期患者122只眼行玻璃体手术治疗后发生玻璃体积血25只眼的临床资料。结果：玻璃体切割手术后发生玻璃体积血占本组玻璃体切割手术患者的20．5％。积血发生在手术后1周内者8只眼，1周至1个月者6只眼，1个月以上者11只眼。25只眼中C3F8填充眼占31．1％，硅油填充眼占6．1％；空气填充眼占33．3％；灌注液填充眼占26．3％。视网膜周边部新生血管增生9只眼。3只硅油填充眼中2只眼积血自行吸收，1只眼局部形成视网膜前膜，在硅油取出同时行前膜剥除；22只非硅油填充眼中6只眼积血自行吸收；2只眼积血加重，但未及时处理，1只眼发生新生血管性青光眼，1只眼广泛玻璃体视网膜增生脱离，视力无光感；14只眼观察2周积血无吸收后进行了再次手术治疗，12只眼1次手术处理后未再积血。随访结束时，视力无光感者3只眼，手动者2只眼，数指～0．1者10只眼，0.3及以下者4只眼，0．3以上者6只眼。结论：DR玻璃体切割手术后发生玻璃体积血的患者多数有周边部新生血管增生，经过及时手术治疗，预后较好。
Objective To analyze the reasons, methods of treatment, and effects on prognosis of vitreous hemorrhage after vitrectomy in patients with diabetic retinopathy. Methods The clinical data of 98 patients （122 eyes） with diabetic retinopathy （VI stage） who had undergone vitrectomy were retrospectively analyzed. Results Post-vitrectomy vitreous hemorrhage （〉grade 2） was found in 25 eyes with the occurrence of 20.5%, in which the hemorrhage occurred 1 week after the surgery in 8 eyes, 1 week to 1 month in 6 eyes, and more than 1 month in 11 eyes. In the 25 eyes, C3F8 tamponade eyes occupied 31.1%, silicone oil tamponade eyes occupied 6. 1%, air tamponade eyes occupied 33. 3%, and infusion solution tamponade eyes occupied 26.3%. Peripheral fibrovascular proliferation was found in 9 eyes. In the 3 eyes with silicone oil tamponade, the hemorrhage was absorbed in 2, and epiretinal membrane was found in 1 which was moved when the silicon oil was taken out. In the 22 eyes without silicone oil tamponade, the hemorrhage was absorbed in 6 and aggravated in 2 without any timely treatment, neovascular glaucoma occurred in 1, and wide vitreo-retinal proliferation and retinal detachment was observed in 1 with the visual acuity of no light perception. Operations such as fluid-air exchange, vitrectomy were performed on 14 eyes 2 weeks after the hemorrhage absorption stopped. Recurrent vitreous hemorrhage was not found in 12 eyes after single operation. At the end of the follow-up period, the visual acuity was no light perception in 3 eyes, hand moving in 2 eyes, counting finger-0.1 in 10 eyes, under 0. 3 in 4 eyes, and over 0.3 in 6 eyes. Conclusion Most of the patients with vitreous hemorrhage after vitrectomy due to DR had peripheral fibrovascular proliferation. The visual prognosis after re-operation is good.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2007年第4期241-243,共3页
Chinese Journal of Ocular Fundus Diseases
