手术治疗增生期糖尿病性视网膜病变临床特点分析  

Analysis on clinical characteristics of surgically treated breeding stage diabetic retinopathy

作　　者：姜世怀[1] 王超[1] 冯源[1] 吴子镜 陈静[1] 

机构地区：[1]四川省绵阳市中医医院南桥眼科分院,621000

出　　处：《临床眼科杂志》2013年第5期433-435,共3页Journal of Clinical Ophthalmology

摘　　要：目的分析手术治疗增生期糖尿病性视网膜病变（PDR）临床特点。方法回顾性分析我院2009年5月至2011年12月的加例（52只眼）糖尿病视网膜病变（DR）的病历及随访资料，其中男15例，女25例，年龄31-78岁，全部患者术前均进行视力、眼压、裂隙灯显微镜、眼底检查、眼B型超声、角膜内皮镜等检查，术后1、2周，1、2．3、6个月随访，围手术期观察血糖、血压、全身情况。对糖尿病相关的全身合并症进行记分，每1种合并症记1分，无合并症记0分。手术方式为玻璃体切除＋全视网膜光凝、合并黄斑水肿及黄斑前膜的行黄斑内界膜剥离，合并白内障者同期行白内障超声乳化吸出，一期植入或不植入人工晶状体。结果1次手术治愈的47只眼（90．4％），再次手术的5只眼（9．6％），术后早期轻度玻璃体再出血5只眼（9．6％），晚期玻璃体再出血合并新生血管性青光眼1只眼（1．9％）。联合白内障超声乳化吸出术的26只眼（50％），其中同期植入人工晶状体的24只眼（46．2％），术后出现瞳孔区或人工晶状体表面渗出的9只眼（17．3％），4只眼（7．7％）于术后发生虹膜后粘连、瞳孔阻滞、继发性青光眼，感染性眼内炎1只眼（1．9％）。围手术期发生血糖波动的17例（42．5％），术中血压波动实施控制性降压的5例（12．5％），肠道植物神经功能异常2l例（52．5％），肾功能异常的8例（20％）。患有全身合并症的患者为17例（42．5％），无合并症的23例（57．5％），评分为0分的23例、1分9例（22．5％）、2分4（10％）、3分3例（7．5％）、4分1例（2．5％）。结论手术治疗PDR，围手术期可能存在血糖、血压波动、肠道植物神经功能异常、肾功能异常等问题。联合手术术后易出现虹膜炎、继发性青光眼等并发症，一期人工晶状体植入的术眼发生感染性眼内炎�Objective We analyzed the clinical manifestatious and outcomes of surgically treated breeding stage diabetic retinopathy （PDR）. Methods This is a retrospective report. Medical and follow -up records of 40 cases （ 15 male, 25 female, total 52 eyes） of diabetic retinopathy treated in our hospital from May 2009 to December 2011 were analyzed. Average patient age was 31 -78 years. All patients were examined for visual acuity, corneal endothelial, intraecular pressure, fundus, etc. before the surgery and 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after the surgery. Perioperative blood glucose, blood pressure, systemic conditions were also recorded. Diabetes related systemic complications were recorded with scoring system in which each complication counts 1. Standard surgery method was vitrectomy plus full retinal photocoagulation. Internal limiting membrane peeling was done for those with macular edema and macular membrane. Phacoemulsification with or without stage I IOL implantation was done in patients with complicated cataract. Resuits The outcomes of the surgeries are as following： forty-seven eyes （90. 4% ） cured with one operation; five eyes （9. 6% ） had mild vitreous hemorrhage in early postoperative period; five eyes （9.6%） had vitreous hemorrhage in late postoperative period; in 1 eye （ 1.9% ）, late postoperative vitreous hemorrhage was complicated with neovascular glaucoma. Phacoemulsification was done in 26 eyes （50%）, among which IOL was implanted in 2.4 eyes （46.2%）. In 9 eyes （17. 3% ） there were exudations in pupil area or IOL surface. In 4 eyes （7.7% ） posterior iris adhesion and secondary glaucoma occurred. Infectious endopbthaimitis was found in 1 eye （ 1.9% ）. Perioperative blood glucose fluctuations occurred 17 cases （42. 5% ）. Intraoperative blood pressure fluctuation that required treatment occurred in 5 cases （ 12. 5% ）. Gastrointestinal autonomic dysfunction was reported in 21 cases （ 52.5% ）. Eight patients （ 20% ） w

关 键 词：糖尿病性视网膜病变 玻璃体手术 围手术期 并发症 

分 类 号：R779.6[医药卫生—眼科]