糖尿病视网膜病变全视网膜光凝术后玻璃体视网膜界面的变化  

Changes of vitreoretinal interface in patients with proliferative diabetic retinopathy after panretinal photocoagulation

作　　者：符敏[1] 吴伟[1] 唐罗生[2] 陆晓和[1] 

机构地区：[1]南方医科大学珠江医院眼科,广东省广州市510282 [2]中南大学湘雅二院眼科,湖南省长沙市410000

出　　处：《眼科新进展》2014年第11期1038-1041,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金面上项目(编号:81371067)~~

摘　　要：目的观察比较不同时期糖尿病视网膜病变(diabetic retinopathy,DR)患者全视网膜光凝术(panretinal photocoagulation,PRP)前后玻璃体视网膜界面状态的变化。方法将确诊为2型糖尿病的患者132例217眼随机分为四组:单纯糖尿病组、轻中度非增生期糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组、重度NPDR组和增生期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组,另选取正常对照组26例52眼。采用裂隙灯显微镜加前置镜、B超、光学相干断层扫描(optical coherence tomography,OCT)观察各组患者玻璃体视网膜界面的状态,比较各组玻璃体后脱离(posterior vitreous 氉detachment,PVD)的发生率,观察NPDR组、PDR组患者行PRP前后PVD的变化。结果重度NPDR组(48.3%)和PDR组(51.7%)PVD发生率高于正常对照组(7.6%),差异均有统计学意义(P<0.01)。重度NPDR组(38.3%)和PDR组(32.8%)PRP术后完全性PVD发生率(38.3%、32.8%)高于治疗前(16.7%、12.1%),差异均有统计学意义(均为P<0.01)。结论DR常合并异常玻璃体视网膜界面,PRP可以促进增生期DR患者形成完全性PVD,有利于延缓或者阻止DR病变进展,防止视网膜脱离,有利于提高手术疗效。Objective To observe and compare the changes of vitreoretinal interface in patients with proliferative diabetic retinopathy（ PDR） before and after panretinal photocoagulation（ PRP）. Methods A total of 217 eyes of 132 patients with non-insulin dependent diabetes were divided into 4 groups： no DR group,light and moderate NPDR group,severe NPDR group,PDR group,and another 26 normal subjects（ 52 eyes） were chosen as normal control group. All cases were examined by slit lamp microscope combined with supplementary lens,B ultrasound and optical coherence tomography,the posterior vitreous detachment（ PVD） incidences were compared between different groups,the changes of vitreoretinal interface in patients with PDR before and after PRP in NPDR and PDR group were observed and compared. Results The PVD incidence in the severe NPDR group（ 48. 3%） and the PDR group（ 51. 7%） were obviously higher than that in the normal control（ 7. 6%）（ all P〈0. 01）. The rates of patients with completely PVD in the severe NPDR group（ 38. 3%） and the PDR group（ 32. 8%） after PRP were higher than those before PRP（ 16. 7% and 12. 1%）（ P〈0. 01）. Conclusion Abnormal vitreoretinal interface often concomitances with DR,PRP can induce the formation of entirely PVD to delay or prevent the pathological progression of DR and retinal detachment,which is able to improve the efficacy of vitreous operation.

关 键 词：糖尿病视网膜病变 玻璃体视网膜界面 玻璃体后脱离 全视网膜光凝 光学相干断层扫描 

分 类 号：R587.2[医药卫生—内分泌]