23G/25G+玻璃体切除手术治疗增生型糖尿病视网膜病变  

23G/25G+vitrectomy for treatment of proliferative diabetic retinopathy

作　　者：吴伯乐[1] 叶锌铭[1] 高和香[1] 李俊[1] 刘青林[1] 刘林平[1] 胡夏云[1] 滕荣建 张丽娜[1] 沈丽芳[1] 卢向红[1] 

机构地区：[1]浙江省丽水市人民医院眼科,浙江丽水323000

出　　处：《中国现代医生》2015年第31期58-61,64,共5页China Modern Doctor

基　　金：浙江省"十二五"基层卫生适宜技术成果转化工程重大项目(2013T301-14);浙江省丽水市科技局重点学科建设科技项目

摘　　要：目的观察23G／25G＋经结膜切口玻璃体切除手术治疗增生型糖尿病视网膜病变（PDR）的实用性安全性和临床效果，总结微创玻璃体切割术初步的临床经验。方法选取2011年3月～2014年12月行玻璃体切割手术治疗的PDR患者52跟，其中23G手术为28眼，25G＋手术为24只眼纳入研究。所有患者均行视力、眼压、前置镜、眼科彩超或B型超声等检查。23G／25G＋手术完成52例52眼：①23G／25G＋玻璃体切除：②42眼增生膜的切除、分离、分割；③52作全视网膜光凝或补激光光凝；④对8眼因视网膜表面血管膨大扩张引起的出血。予以局部电凝。术中注入C3f8的为18眼，空气5眼，注入硅油5眼。并观察手术中医源性损伤的发生情况,随访3个月，观察视力、眼压及并发症的发生情况。结果52例52眼手术后视力均较手术前明显提高，发生早期低眼压为1只眼，眼内少量出血5眼，术中和术后并无医源性损伤引起白内障、医源孔等发生。结论23G／25G＋玻璃体切除手术治疗PDR，对增生膜的切除、分离、分割更加便捷可靠、对视网膜损伤更小，可缩短手术时间．减少术中医源性损伤的发生并降低手术后早期低眼压发生率。其中25G＋由于其设计更具合理，作者认为25G＋治疗增生型糖尿病视网膜病变（PDR）更有优势。Objective To observe the practicality, safety and clinical effect of 23G/25G＋ vitrectomy through conjunctival incision for the treatment of proliferative diabetic retinopathy（PDR）, and to summarize the preliminary clinical experience of minimally invasive vitreetomy. Methods From March 2011 to December 2014, there were 52 cases enrolled in the study who received vitreetomy surgery, among which 28 received the 23G surgery, while the other 24 received the 25G＋ surgery. All patients underwent a series of tests including visual acuity, intraoeular pressure, front lens, ophthalmic ultrasound or B-mode ultrasound, etc. Surgical procedures as follows were completed in the 52 cases： ①23G/ 25G＋ vitrectomy for all the 52 cases. ②Removal, separation, partition of proliferative membranes for 42 cases.③Photocoagulation or complement laser photoeoagalation for all the 52 cases. ④localized coagulation for 8 cases who had retinal hemorrhage caused by dilated surface blood vessels. 18 cases were injected C3f8, 5 cases were injected air and 5 cases silicone, and the incidence of iatrogenic injury was observed during the surgery. We also followed up 3 months to observe their visual acuity, intraocular pressure and the incidence of complications. Results Visual acuity of all the 52 cases had significantly improved after surgery. Early hypotony occurred in 1 case, intraocular bleeding occurred in 5 cases. No cataracts or medical sources hole caused by iatrogenic injury occurred intraoperative or postoperative. Conclusion 23G/25G＋ vitrectomy surgery for PDR is more convenient and reliable for the removal, separation, segmentation of proliferative membranes, and causes less damage to the retina. Also, 23G/25G＋ vitrectomy can shorten the op- eration time, and reduce the incidence of intraoperative iatrogenic injury and postoperative early hypotony. Moreover, 25G＋ vitrectomy surgery for PDR has more advantage due to it smore reasonable design.

关 键 词：23G/25G+ 糖尿病视网膜病变 外科学 微创性 玻璃体切除术 

分 类 号：R774.1[医药卫生—眼科]