两种联合术式人工晶状体植入术治疗增生性糖尿病视网膜病变的对比研究  

Comparative study of vitrectomy combined with phacoemulsification or pars plana lensectomy for proliferative diabetic retinopathy

作　　者：詹冬梅[1] 史琴[1] 哈玲芳[1] 武淑玲[1] 

机构地区：[1]宁夏医科大学总医院眼科,宁夏回族自治区银川市750004

出　　处：《眼科新进展》2015年第3期266-269,共4页Recent Advances in Ophthalmology

基　　金：宁夏自然科学基金资助(编号:NZ10129)~~

摘　　要：目的对比分析两种联合术式人工晶状体植入术治疗增生性糖尿病视网膜病变的安全性和有效性。方法回顾性分析2011年3月至2013年10月我院收治的增生性糖尿病视网膜病变行联合手术的患者95例（95眼）,随机分为两组,术式1组49眼行白内障超声乳化术联合玻璃体切割囊袋内植入后房型人工晶状体;术式2组46眼行玻璃体手术中后路切除晶状体,保留前囊膜,前囊上睫状体沟内植入人工晶状体。观察两组患者术后视力改善及术后并发症情况。术后随访5个月~2.5 a。结果术式1组视力改善40眼（81.63%）;术式2组视力改善28眼（60.87%）,两组术后视力改善眼数比较差异有统计学意义（χ2=5.028,P=0.025）。术式1组术后发生虹膜新生血管（iris neovascuiarization,INV）1眼;术式2组术后发生INV7眼,两组术后INV发生率差异有统计学意义（χ2=5.342,P=0.021）。两组患者术后视力改善不佳者多伴有明显的糖尿病黄斑水肿、硬性渗出或视网膜缺血。术后主要并发症包括：角膜水肿（术式1组12眼,术式2组5眼）、暂时性眼压升高（术式1组4眼,术式2组5眼）、葡萄膜炎表现（术式1组16眼,术式2组14眼）、玻璃体积血（术式1组4眼,术式2组6眼）、视网膜脱离（两组均为2眼）、新生血管性青光眼（术式1组1眼,术式2组5眼）、后发性白内障（术式1组7眼,术式2组6眼）。结论玻璃体切割联合晶状体手术治疗合并白内障的增生性糖尿病视网膜病变是安全有效的;术式l组优于术式2组,其术后INV和新生血管性青光眼的发生率也较低;糖尿病黄斑病变是影响术后视力提高的主要原因。Objective To evaluate the safety and effectiveness of vitrectomy combined with phacoemulsification or pars plana lensectomy for eyes with proliferative diabetic retinopathy.Methods Retrospective analysis were performed about the clinical data of 95 cases（ 95 eyes）with cataract and proliferative diabetic retinopathy who were received two different combined surgery from March 2011 to October 2013 in our hospital. Two groups were divided, and 49 eyes received the techniques of vitrectomy combined with phacoemulsification as group one, intraocular lens（ IOL） was implanted into the intracapsule. Another 46 eyes were treated with vitrectomy combined with lensectomy via the pars plana as group two, the IOL was inserted on the anterior capsule. Postoperative visual acuity and surgical complications were analyzed. Results The postoperative follow-up interval ranged from 5 months to 2. 5 years. The visual improvement were achieved in 40 eyes（ 81. 63%） of group one and 28 eyes（ 60. 87%） of group two, there was statistical difference（ χ2 = 5. 028,P= 0. 025）. The eyes with low visual acuity were associated with significant diabetic macular edema,abundant macular exudate and severe ischemia. Iris neovascuiarization appeared in 1 eye（ 2. 04%） of group one and 7 eyes of group two（ 15. 22%） after surgery, there was statistical difference（ χ2 = 5. 342,P = 0. 021）. Postoperative complications included corneal edema（ 12 eyes in group 1 and 5 eyes in group 2）, transient intraocular pressure increase（ 4 eyes in group 1 and 5 eyes in group 2）,uveitis（ 16 eyes in group 1 and 14 eyes in group 2）, vitreous hemorrhage（ 4 eyes in group 1 and 6 eyes in group 2）, retinal detachment（ 2 eyes in both groups）,neovascular glaucoma（ 1 eye in group 1 and 5 eyes in group 2）,posterior capsule opacification（ 7eyes in group 1 and 6 eyes in group 2）. Conclusion Combined surgery in the treatment of cataract and proliferative diabetic retinopathy is safe and effective. Phacoemusification and sim

关 键 词：增生性糖尿病视网膜病变 超声乳化术 玻璃体切割术 晶状体切割术 虹膜新生血管 

分 类 号：R587.2[医药卫生—内分泌]