白内障超声乳化吸除联合玻璃体切除治疗增生性糖尿病视网膜病变的临床研究  

Clinical observation of phacoemulsification combined with vitrectomy for prolilferative diabetic retinopathy

作　　者：周林[1] 冯军[1] 邹玉平[2] 黄素英[2] 

机构地区：[1]徐州医学院附属淮安医院眼科,223002 [2]中山大学中山眼科中心眼科学国家重点实验室

出　　处：《临床眼科杂志》2011年第5期414-417,共4页Journal of Clinical Ophthalmology

摘　　要：目的探讨超声乳化联合玻璃体切除和后路晶状体切除术联合玻璃体切除两种手术方式在白内障合并增生性糖尿病视网膜病变(PDR)治疗中的临床疗效。方法分析60例(73只眼),分2组,术式1组40只眼,为常规白内障超声乳化术联合标准闭合式三通道玻璃体切除及眼内光凝、囊袋内植入后房型人工晶状体;术式2组33只眼,为经扁平部玻璃体术中先切除晶状体及后囊膜,保留前囊并吸刮上皮层、后段玻璃体切除和眼内光凝后,再从角巩膜缘切口,将人工晶状体植入前囊上、睫状体沟内,环型切除前囊中央直径4.5～5 mm左右的前囊组织。结果术后随访2个月至3年,术式1组视力改善32只眼,占80.00%,术式2组视力改善23只眼,占69.70%,两组术后视力改善眼数比较差异有统计学意义(χ2=4.763,P<0.05)。术式1组术后发生虹膜新生血管(INV)1只眼,占2.50%;术式2组术后发生INV 7只眼,占21.21%,两组术后INV发生率差异有统计学意义(χ2=5.837,P<0.05)。结论在治疗白内障合并PDR患者中,术式1组优于术式2组,其术后并发症和INV的发生率也明显低,可使大多数患者的视力改善的视力改善。Objective To investigate the efficacy of phacoemulsification or pars plana lensectomy combined with vitrectomy in the treatment of proliferative diabetic retinopathy and cataract.Methods Sixty cases（73 eyes） with PDR and cataract undergone 2 different combined surgeries from May 2007 to May 2010 in our hospital were reviewed,the cases divided into 2 groups.Group 1 was the techniques included phacoemulsification combined vitrectomy,IOL was inserted into the introcapsule,via the corneasleral incision.Group 2 was the techniques of lensectomy via the pars plana combined posterior segment surgeries.The anterior capsule was preserved and the epithelium was suctioned and scraped off.IOL was inserted via the corneascleral incision on the anterior capsule,of which the center area 4.5～5 mm in diameter was cut.Results Sixty cases including 73 eyes after surgery were followed-up for 2 months to 3 years.Postoperatively,There were significanted differences between two groups.In visual improvement which was achieved in 32 eyes（80.00%）in group 1,in 23 eyes（69.70%）in group 2.There were significant difference between,two,groupsin,visual,improvement（χ~2=4.763,P〈0.05）.Iris neovascularization（INV）occurred in one eye in group 1（2.50 %） and 7 eyes in group 2（21.21%）during 1.5～11 months.After,surgery（χ~2=5.837,P〈0.05）.Conclusion Phacoemusification and simultaneous introcapsule lens implantation combined with vitrectomy in the treatment of proliferative diabetic retinopathy and cataract is more effective than pars plana lensectomy combined with vitrectomy.The surgery obviously improves the visual outcome in the majority of selected eyes with less significant complications and less iris neovascularization（INV）.

关 键 词：晶状体超声乳化术 增生性糖尿病视网膜病变 玻璃体切除术 晶状体切除术 

分 类 号：R779.66[医药卫生—眼科]