保留晶状体前囊膜的玻璃体切除术联合超全视网膜光凝治疗PDR  

Clinical investigation on vitrectomy reserved anterior capsule combining with extra retinal photocoagulation for proliferative diabetic retinopathy

作　　者：陈乔[1] 聂尚武[1] 王晓琴[1] 

机构地区：[1]中国湖北省荆州市中心医院眼科,434020

出　　处：《国际眼科杂志》2015年第9期1609-1611,共3页International Eye Science

摘　　要：目的：探讨保留晶状体前囊膜的玻璃体切除术联合术中超全视网膜光凝在增殖型糖尿病视网膜病变（PDR）遇期合并白内障的临床应用。方法：回顾性分析2010-01/2013-06于我院收治的PDR遇期合并白内障患者38例45眼,术前视力均为光感至0.1,入院后行保留晶状体前囊膜的玻璃体切除术,术中行超全视网膜光凝（E-PRP）,术毕所有眼均行硅油填充,术后随访12-26mo,观察眼压、视力、眼前节及眼后节情况。结果：术后32眼（71%）视力提高,13眼（29%）视力未提高,BCVA≥0.05的有23眼,较术前有显著差异（χ2=16.80,P〈0.01）,39眼（87%）视网膜复位良好,2眼（4%）出现硅油依赖眼,7眼（16%）合并视网膜前增殖膜。术后1眼（2%）虹膜新生血管（INV）进展为新生血管性青光眼,4眼INV逐渐消退,但较术前差异无显著性（χ2=1.61,P=0.21）。术后出现一过性高眼压11眼（24%）,一过性角膜水肿8眼（18%）,前房纤维渗出6眼（13%）,虹膜后粘连2眼（4%）,前囊膜混浊13眼（29%）。结论：对于PDR遇期合并白内障的患者,保留晶状体前囊膜的玻璃体切除术联合术中超全视网膜光凝是安全有效的,能提高术后视力,有效地复位视网膜。同时可能减少INV的发生。AIM： To evaluate the preservation of anterior capsule used in vitrectomy combined with extra retinal photocoagulation for proliferative diabetic retinopathy （PDR） stage Ⅵ with cataract. METHODS： Retrospective analysis of 38 patients （45 eyes） with PDR stage Ⅵ with cataract in our hospital from January 2010 to June 2013, preoperative visual acuity were LP to 0.1, underwent vitrectomy reserved anterior capsule and intraoperative extra retinal photocoagulation （E-PRP） with silicone oil tamponade in all eyes. Patients were followed up for 12 - 26mo to observe the intraocular pressure, visual acuity, anterior and posterior segment conditions. RESULTS： Postoperatively 32 eyes （71%） improved in visual acuity and 13 eyes （29%） didn＇t improve, 23 eyes with BCVA ≥0.05 there was a significant difference （X2 = 16.80, P〈0.01 ） compared with preoperative. Anatomic retinal attachment was achieved in 39 eyes （87%）. There were 2 eyes （4%） of silicone oil dependence and 7 eyes （16%） with epiretinal proliferative membrane. One eye （2%） was found iris neovascularization （INV） and progressed to neovascular glaucoma, 4 INV eyes gradually subsided, but there was no significant difference compared with the preoperative （X2 = 1.61, P= 0. 21 ）. The postoperative complication incidence of transient intraocular pressure rise, corneal edema, anterior chamber fibrin exudation, posterior synechia and anterior capsule opacification was 24% （11 eyes）, 18% （8 eyes）, 13% （6 eyes）, 4% （2 eyes） and 29% （13 eyes）. CONCLUSION. The preservation of anterior capsule invitrectomy combined with E-PRP is safe and effective for patients with PDR stage Ⅵ with cataract. It can improve postoperative visual acuity and reattach retina effectively, and may also reduce the incidence of iris neovascularization.

关 键 词：玻璃体切除术 晶状体切除术 超全视网膜光凝 增殖型糖尿病视网膜病变 

分 类 号：R779.6[医药卫生—眼科]