摘要
目的研究玻璃体手术治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)后采用不同眼内填充物的效果。方法对451例(536眼)行玻璃体手术治疗的PDR连续性病例从视力预后、视网膜复位、虹膜新生血管的发生、白内障形成、玻璃体再出血的角度进行回顾性分析。结果主要依据术前或术中是否出现视网膜裂孔来选择眼内填充物,总的视网膜在位率92.54%;保留灌注液患者显示出更好的视力提高率(76.24%)和视网膜复位率(92.00%),低的虹膜新生血管发生率(2.78%)和白内障发生率(8.11%),保留灌注液和填充其他填充物总视网膜复位率无统计学差异(P=0.055),保留灌注液、填充气体、填充硅油的术后玻璃体再出血均以少量为主,以填充气体组的再出血率最低(10.14%)。结论术前或术中是否合并视网膜裂孔是PDR病例玻璃体手术选择眼内填充物的重要因素,PDRⅥ期并不是选择眼内填充物的指征,提高手术技巧、减少术中医源性裂孔形成可以减少硅油或气体的使用,以避免二次手术硅油取出和并发症发生。
Objective To study the effect of different intraocular tamponade during vitrectomy on proliferative diabetic retinopathy. Methods Retrospective analysis was taken at the visual outcome,retina reattached rate, the development of iris neovascularization, postoperative cataract and postoperative vitreous hemorrhage of 451 consecutive patients（ 536 eyes） who underwent vitrectomies for proliferative diabetic retinopathy. Results Preoperative or iatrogenic retinal breaks or not were chosen as one major factor of the intraocular tamponade indications. The total rate of attached retina was 92.54%. Irrigating solutions group showed better outcome than other groups：visual acuity improvement in 76.42%, retina reattachment in 92.00%, rubeosis iridis in 2.78% and cataract in 8.11%. There was no statistical significance in the reattachment rate of retina between irrigating group and the total of other tamponade groups （P= 0. 055） ; Mild postoperative vitreous hemorrhage happened most often in all the three groups and the rehemorrhage rate of the tamponade gas group was the lowest （ 10. 14% ）. Conclusion Whether there are preoperative or iatrogenic retinal breaks is important for choosing intraocular tamponade during the vitrectomy on proliferative diabetic retinopathy eyes. Proliferative diabetic retinopathy Ⅵ stage was not the indication to choose tamponade. Improving the operative skills and the absence of the iatrogenic retinal breaks can avoid the abuse of gas or silicone oil, which may avoid the tamponade complications and the dislodgement of tamponade at the second operation. [ Rec Adv Ophthalmol 2008 ;28 （ 2 ） ： 119-121,124 ]
出处
《眼科新进展》
CAS
2008年第2期119-121,124,共4页
Recent Advances in Ophthalmology
基金
北京市自然科学基金资助(编号:7062065)~~
关键词
增生性糖尿病视网膜病变
玻璃体切割术
硅油
灌注液
膨胀气体
proliferative diabetic retinopathy
vitrectomy
silicone oil
intraocular irrigating solution
tamponade gases
