严重糖尿病性增殖性玻璃体视网膜病变的手术治疗  

Vitrectomy for severe proliferative diabetic vitreoretinopathy

作　　者：赵铁英[1] 罗康怡[1] 陈青山[1] 欧阳芳[1] 冯其高[1] 

机构地区：[1]暨南大学医学院深圳眼科中心深圳市眼科医院,深圳518001

出　　处：《中国实用眼科杂志》2004年第8期596-597,共2页Chinese Journal of Practical Ophthalmology

摘　　要：目的　观察严重糖尿病性增殖性玻璃体视网膜病变 (diabeticproliferativevitreo retinopathy ,DPVR)术中所见特点 ,及其手术方法特点、填充材料应用选择及术后疗效。 方法　回顾分析 3 3例 3 4眼DPVR患者进行玻璃体切割、膜剥离、眼内激光光凝并根据情况选用眼内长效填充材料的病例。结果　术中见所有病例均有不完全玻璃体后脱离 ,玻璃体后皮质及纤维增殖膜呈强直状 ,与视网膜紧密粘连处、多位于视神经乳头及血管表面 ,需行分段剪开、进行蚕蚀式切割 ,先易后难剥离切除。术后随访 3～ 2 4个月 ,3 3 /3 4眼 (占 97% )一次解剖成功 ;3 4眼视力均有不同程度提高 ,0 0 5以上 2 6眼 (占 76 5 % ) ,与术前相比差异有显著性 (P <0 0 5 ) ;7眼视力 0 2～ 0 7。结论　玻璃体切割、不同于外伤等手术方法的玻璃体后皮质及纤维增殖膜的安全剥除、切割 ,眼内光凝 ,结合眼内填充是挽救严重PDVR患眼最终失明的有效方法。Objective To observe the features during the surgery,the surgical techniques,the selection of temponade materials and the clinical efficacy of vitrectomy in the treatment of severe proliferative diabetic vitreoretinopathy(PDVR).Methods A series of PDVR(34 eyes of 34 cases)treated by vitrectomy were retrospectively analyzed.Vitreous removal,membrane peeling,photocoagulation and temponade were carried out during the operations.Results All cases exhibited a kind of incomplete posterior vitreous detachement(PVD)with some dense adherent sites between the proliferative membranes and the surface of retinal disc and big vessels.The adjacent posterior vitreous cortex(PVC)and proliferative membranes were separated carefully step by step,cut into segments and then removed little by little.All the patients were followed up postoperatively for 6～12 months.Anatomical recovery was achieved primarily in 33(33/34,97%)cases.Visual acuity increases in all 34 eyes,26 eyes were above 0 05(26/34,76 5%),which had statistically significant difference compared with that before operation.7 eyes obtained an uncorrected visual acuity up to 0 2～0 7.Conclusions Vitrectomy using specific surgical techniques separating and cutting PVC and proliferative membranes,combined with photocoagulation and different temponade,should be considered as an effective method to save the vision in PDVR patients.

关 键 词：糖尿病性增殖性玻璃体视网膜病变 治疗 外科手术 玻璃体切割 膜剥离 

分 类 号：R774.1[医药卫生—眼科]