联合手术治疗增生性糖尿病视网膜病变的研究  

The clinical observation of combined surgery for proliferative diabetic retinopathy.

作　　者：周林[1] 邹玉平[2] 黄素英[2] 冯军[1] 

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

出　　处：《中华眼外伤职业眼病杂志》2012年第1期32-36,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评价玻璃体切除联合晶状体切除或超声乳化吸出人工晶状体植入术（联合手术）和单纯玻璃体切除术治疗伴有轻度白内障的增生性糖尿病视网膜病变的临床效果。方法回顾性分析了32例（40眼）联合手术与28例（33眼）单纯玻璃体切除术治疗的增生性糖尿病视网膜病变的临床资料，包括手术前后的眼部状况、视力及手术并发症等。结果两组手术后视力较术前提高者，联合手术组占77．50％，单纯玻切组占66．67％，两组之间差异有统计学意义（∥=4．74，P〈0．05）。联合手术组术前5眼虹膜新生血管在术后1-2个月内5眼均完全消退，单纯玻璃体切除组7眼中仅有1眼完全消退。联合手术组有9眼术后前房内纤维素渗出膜形成，单纯玻璃体切除组只有I眼。联合手术组有7眼术后形成虹膜后粘连，单纯玻璃体切除组只有1眼。结论联合手术治疗增生性糖尿病视网膜病变是安全有效的，可较早恢复视力，避免再次行白内障手术，但联合手术后前房炎性反应、虹膜后粘连的发生率较高。Objective To compare the effect of vitrectomy combined with pars plana lensectomy or phacoemulsification, intraoeular lens implantation（ combined vitrectomy） , and pars plana vitreetomy alone on retinal disorders resulting from diabetic retinopathy. Methods The clinical data, vision, and complications of 32 patients （40 eyes ）who underwent combined vitreetomy and 28 patients （33 eyes）who underwent vitrec- tomy alone retrospectively were analyzed. Results Final visual acuity were all improved in the two groups, which was achieved in 31 eyes in group of combined vitrectomy （ 77.50% ） , in 22 eyes in group of vitrecto- my alone （66.67%）. There were significant difference between them（x2 =4. 74, P 〈0. 05）. Five eyes with preoperative iris neovaseularization was completely fade away within 1 -2 months in combined vitrecto- my group, while only 1 eye in vitreetomy alone group. Nine eyes were found postoperative fibrin formation in combined vitrectomy group and only 1 eye in vitrectomy alone group. Seven eyes occurred posterior synechia in combined vitrectomy group and 1 eye in vitrectomy alone group. Conclusion Combined phacoemulsifi- cation, intraocular lens implantation with vitrectomy（ combined vitrectomy）is safe and effective in treating patients with proliferative diabetic retinopathy. It could avoided second operation for postvitrectomy cataract, and help earlier visual rehabilitation, but it may increase the incidence of fibrin formation and posterior syn- echia of the iris.

关 键 词：糖尿病视网膜病变 玻璃体切除术 晶状体超声乳化吸出术 

分 类 号：R779.6[医药卫生—眼科]