摘要
目的:探讨2型增生性糖尿病视网膜病变(Proliferative diabetic retinopathy,PDR)的手术时机和技巧,提高其复明率。方法:PDR患者共93人143眼,PDR早期33人52眼(玻璃体积血)、中期47人71眼(纤维血管增殖膜+玻璃体积血)、晚期13人20眼(纤维血管增殖膜合并视网膜脱离),术前、术中玻璃体腔注入曲安奈德(Triamcinolone acetonide,TA)4 mg/0.1 ml,行标准玻璃体切割术,合并白内障者联合超声乳化摘除(部分植入人工晶体),行部分或全视网膜激光,根据情况决定眼内填充物(平衡盐液、惰性气体、硅油)。观察术后视力、术中及术后(术后1月)出血、前房炎症反应、视网膜情况及眼压变化,随访3个月并行眼底、眼底荧光素血管造影(Fundus fluorescein angiography,FFA)及光相干断层成像术(Optical coherence tomography,OCT)检查。结果:(1)早期手术较晚期手术视力明显提高,差异具有统计学意义;(2)早期PDR术中及术后无明显出血发生,3眼中期PDR发生术中出血,晚期PDR患者2眼术中出血、3眼术后出血。(3)早、中、晚期PDR患者术后均有一过性眼压升高,早期10眼、中期12眼、晚期3眼,联合手术发生率高。结论:PDR患者尽早手术有利于其视力预后。PDR患者术前、术中使用TA有助于提高视力,稳定病情,减少并发症的发生。
Objective：To explore the operational opportunity and methods for proliferative diabetic retinopathy（PDR） among type 2 diabetes mellitus patients.Methods：Three groups of PDR in 93 patients（143 eyes） with type 2 diabetes were analyzed retrospectively：eyes with only vitreous hemorrhage（52 eyes,33 patients）,vitreous hemorrhage ＋fibrovascular membranes（71 eyes,47 patients）and vitreous hemorrhage ＋ traction retinal detachment（20 eyes,13 patients）were diagnosed as Mild PDR,Moderate PDR and Severe PDR respectively.Four mg triamcinolone acetonide（TA） was injected into the vitreous cavity before and in the vitrectomy.In the operations,phacoemulsification（phaco）,phaco＋intraocular lens（IOL）,partial photocoagulation and panretinal endophotocoagulation were combined according to situation.Perfluorohexane or perfluoropropane gases and silicone oil were used as intraocular filling material dependent on the individual＇s clinical situation.Visual acuity after operation,hemorrhage in operation and one month after operation,inflammation response in the anterior chamber,retinal conditions and intraocular pressure were observed.Examination of retina and macular,fluorescein angiography（FFA） and optical coherence tomography（OCT） were performed three months after operation.Results：（1）The visual acuity of patients with mild PDR increased much more than severe PDR ones.（2）No obvious hemorrhage happened in and after operation in mild PDR eyes.Hemorrhage happened in operation in three moderate PDR eyes,in 2 severe PDR eyes in operation,and in 3 severe ones after operation.（3）Intraocular pressure increased temporarily in some of the three group eyes,including 10 eyes with mild PDR,12 with the moderate PDR and 3 with the severe PDR.The increase of intraocular pressure happened especially in the combined operations of phaco/ endophotocoagulation.Conclusion：Vitrectomy in the mild PDR eyes,intravitreal injection of TA before and in the operation contribute to the prognosis of PDR.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2011年第6期754-756,共3页
Journal of Chongqing Medical University
