微创玻璃体视网膜手术治疗糖尿病玻璃体积血观察  

Therapeutic effect of micro-invasive vitrectomy for diabetic vitreous hemorrhage

作　　者：孙吉君[1] 孙敏[1] 李聪慧[1] 刘文[1] 任增金[1] 胡志翔[1] 柯治生[1] 王瑞华[1] 宋宗明[1] 

机构地区：[1]温州医学院附属眼视光医院,浙江温州325027

出　　处：《中国实用眼科杂志》2013年第2期115-119,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价微创玻璃体视网膜手术治疗糖尿病玻璃体积血的手术效果。方法回顾性病例系列研究。对2008年10月至2011年10月在温州眼视光医院因糖尿病玻璃体积血行微创玻璃体视网膜手术的病人68例（82只眼）。所有患者均行23G（Guage）联合25G经结膜无缝合玻璃体切割术。术后随访平均9个月（6～16月），观察术后最佳矫正视力（best-correctedvisualacuity，BCVA）、眼压、玻璃体积血复发率及术中术后并发症。结果术后75只眼（91．5％）视力提高，患者术前平均视力LogMAR（1．68±0．57），术后1周平均视力LogMAR（1．17±0．61）；末次随访平均视力为LogMAR（0．58±0．45），较术前视力均明显提高，差异有统计学意义（t=5．44，P〈0．05，t=12．75，P〈O．05）。术中发现黄斑水肿的患者末次随访时视力较差。手术当天、术后1d、2d、3d内眼压无明显变化，末次随访时眼压略有升高。随访期内再次发生玻璃体积血6只眼（7．3％），一过性高眼压14只眼（17．1％），新生血管性青光眼2只眼（17．1％），孔源性视网膜脱离2只眼（17．1％），此外术中及术后无严重并发症。结论微创玻璃体视网膜手术是治疗糖尿病玻璃体积血的安全有效方法。Objective To evaluate the safety and efficacy of micro-invasive vitrectomy in cases with dense diabetic vitreous hemorrhage. Methods Retrospective, consecutive, interventional cases series of 82 eyes of 68 patients with diabetic vitreous hemorrhage who underwent 3-port pars plana vitrectomy using 23-guage instrumentation and 25-gauge infusion. Follow-up 9 months （mean 6-16 months）. Main outcome measures were pre- and post- BCVA, intraocular pressure and complications. Results The postoperative visual acuities improved in 75 eyes （91.5%）. The mean BCVA improved from LogMAR1.68±0.57 preoperatively to LogMAR 1.174±0.61 at one week after surgery with significant statistical difference （t =5.44, P 〈0.05）. At the final follow-up, the mean BCVA was LogMAR0.58±0.45 which also with significant statistical difference （t =12.75, P 〈0.05） compared with pre-BCVA, and the mean BCVA of patients who had been found macular edema during operation was poor than those had not been found patients. No statistical difference was found among the intraocular pressure of operation day, one day and the following two days after operation. The intraocular pressure of final follow-up was a little higher than pre-operation. There were 6 eyes （7.3%） with recurrent vitreous hemorrhage, temporary intraocular hypertension in 14 eyes （17.1%）, neovascular glaucoma in 2 eyes （17.1%）, rhegmatogenous retinal detachment in 2 eyes （17.1%）. Conclusions Micro-invasive vitrectomy is a feasible treatment for cases with dense diabetic vitreous hemorrhage.

关 键 词：微创玻璃体视网膜手术 糖尿病玻璃体积血 治疗结果 

分 类 号：R771.3[医药卫生—眼科]