玻璃体切除联合不同眼内填充物治疗增性糖尿病视网膜病变的效果分析  

Different intraocular tamponade during vitrectomy on proliferative diabetic retinopathy

作　　者：范传峰[1] 王玉[1] 舒相汶[1] 张华[1] 盛艳娟[1] 吴昌龙[1] 谭瑞礼[1] 张同河[1] 

机构地区：[1]山东济南市第二人民医院眼科,250001

出　　处：《中国实用眼科杂志》2009年第9期989-992,共4页Chinese Journal of Practical Ophthalmology

基　　金：济南科学技术局科技计划项目（061035）

摘　　要：目的评估增殖型糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）行玻璃体切割术的治疗效果。对PDR不同分期以及联合不同填充物的视力和并发症情况进行观察和比较，探讨其预后的差别。方法对因PDR行玻璃体手术的病例300例（384只眼）进行随访，根据玻璃体切割术后不同填充物分为硅油填充组、全氟丙烷填充组和平衡盐水组三组，比较各组间的视力预后及并发症发生情况。结果（1）术后视力：在观察的384只眼中，随访时视力较术前提高者有271只眼（70．6％）；其中保留BSS灌注液患者中有78只眼（84．8％），填充气体患者有58眼（70．7％），填充硅油患者135只眼（64．3％）视力提高。经x^2检验，各组间视力提高比例的差别无统计学意义（均P〉0．05）。（2）术后并发症：玻璃体再出血发生率以填充BSS组最高（23．9％），与硅油填充组（10．5％）比较差异有统计学（P〈0．05）；并发性白内障以硅油填充组（26．4％）最高，与填充BSS组相比差异具有统计学意义（P〈0．05）；视网膜脱离发生率以硅油填充组最高，与填充BSS组相比差异具有统计学意义（P〈0．05）；不同填充物各组间虹膜红变发生率未显示统计学差异。结论（1）玻璃体切割联合不同填充物能有效地控制病情，及时有效的玻璃体手术是挽救严重PDR患者有用视功能的关键。（2）玻璃体出血、视网膜脱离、并发性白内障和青光眼是PDR患者玻璃体切割术后主要的并发症。硅油填充组的玻璃体出血发生率少于其他组，但并发性白内障发生率较其他组高；（3）尽管玻璃体切割术联合硅油填充会引起一些并发症，但硅油有屏障、限制出血扩散和视网膜复位的作用，为进一步完成全视网膜激光光凝创造了条件，巩固了手术治疗的效果。Objective To observe the improvement of visual acuity and complications for different stage of proliferative diabetic retinopathy eyes after vitrectomy combined with different tamponade. Methods A total of 384 eyes of 300 patients undergone vitrectomy for PDR were followed up 3-20 months, these cases were divided into three groups according to different tamponade： silicon-oil tamponade group, gas tamponade group and balanced salt solution group. The effect and complications of vitrectomy were compared among these groups. Results 1. Visual acuity after vitrectomy： The final visual acuity increased in 271 eyes （70.6%）. 2. Major postoperative complications included vitreous hemorrhage, cataract, retinal detachment and iris neovasculation. The incidence of vitreous hemorrhage was the highest in balanced salt solution group, and the incidence of cataract and retinal detachment was the highest in silicon-oil tamponade group, the incidence of iris neovasculation had no distinct differences among the three groups. Conclusions 1. The majority of PDR eyes can be controlled effectively, obtained better visual improvement after vitrectomy combined with different tamponade. 2. The causes of postoperative visual loss in present study included vitreous hemorrhage, retinal detachment, complicated cataract and iris neovasculation. The rates of vitreous hemorrhage in silicon-oil tampon- ade group are distinctly less than non-tamponade group. The rates of complicated cataract and retinal detachment in silicon-oil tamponade group are higher than inert-gas tamponade group and non-tamponade group. There isn＇t any distinctly difference about the rate of iris neovasculation among these three groups. 3. Though the state of illness is serious and complex after silicon-oil tamponade be used, silicon-oil tamponade may reduce the happen of vitreous hemorrhage and secondary glaucoma distinctly, and increase the success rate of operation.

关 键 词：增殖性糖尿病视网膜病变 玻璃体切除术 填充物 并发症 

分 类 号：R735[医药卫生—肿瘤] R473.77[医药卫生—临床医学]