玻璃体切割联合白内障超声乳化术治疗增生性糖尿病视网膜病变临床研究  

The clinical analysis of micro-invasion vitrectomy combined with phacoemusiflcation for proliferative diabetic retinopathy

作　　者：周爱意[1] 李婷[1] 赵琳[1] 王建明[1] 权彦龙[1] 

机构地区：[1]西安交通大学第二附属医院眼科,710004

出　　处：《中国实用眼科杂志》2016年第1期58-61,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的分析比较玻璃体切割联合或不联合超声乳化人工晶状体植入术治疗增生性糖尿病视网膜病变（PDR）的临床效果、安全性、并发症发生率及角膜内皮细胞丢失量。方法回顾性系列病例研究。对2011年7月至2014年7月在西安交通大学第二附属医院眼科收治的PDR患者80例（80只眼），行23G微创玻璃体切割手术联合或者不联合超声乳化人工晶状体植入术，记录分析术后视力、手术并发症、角膜内皮细胞丢失量。结果玻璃体切割组（PPV组）41只眼行单纯的微创玻璃体切割手术，联合手术组39只眼，行玻璃体切割联合白内障超声乳化人工晶状体植入术。联合手术组术后3月的最佳矫正视力明显优于单纯玻璃体切割组。术后1年，PPV组27只眼视力下降，其中25只眼需要行白内障手术。术后并发症包括一过性眼压升高，角膜水肿，前房炎症反应，后节缺血，玻璃体出血，视网膜脱离，新生血管性青光眼。联合手术组角膜内皮细胞丢失较PPV组多，两组比较差异有统计学意义（P〈0．05）。结论微创玻璃体切割联合超声乳化人工晶状体植入术治疗PDR能更好地提高患眼视力，术中及术后并发症较少，安全有效。联合手术避免了二次手术治疗玻璃体手术后加重的自内障。值得注意的是，需要术中更好的保护角膜内皮细胞和保留后囊膜完整。Objective To evaluate the effectiveness, safety, corneal endothelial cell loss and incidence of complications after combined phacoemulsification with intraocular lens implantation （PE ＆ IOL） and pars plana vitrectomy （PPV） in eyes with proliferative diabetic retinopathy （PDR） compared with the patients underwent PPV without PE ＆ IOL. Methods Eighty patients with proliferative diabetic retinopathy who underwent primary standard three-port vitrectomy with 23-gauge instruments with or without PE ＆ IOL were retrospective reviewed. The main outcome measures were visual outcomes, corneal endothelial cell loss and incidence of complications. Results Forty-one patients （41 eyes） who underwent PPV alone were allocated to the PPV group, and 39 patients （39 eyes） who underwent PPV with PE ＆ IOL were allocated to the combined group. The best corrected visual acuity （BCVA） 3 months after operation of combined group was better than the PPV group. One year after surgery 27 eyes of PPV group （69.2%） had decreased vision and 25 eyes need cataract surgery. Postoperative complications consisted of transient intraocular pressure elevation, corneal epithelial defects, anterior chamber reaction, posterior synechiae, vitreous hemorrhage, retinal detachment, and neovascular glaucoma. The difference of the incidence of surgical complications between two groups was not significant. Corneal endothelial cell loss postoperative was significantly higher after combined phacovitrectomy than after PPV. Conclusions The combined operation of PPV with PE ＆ IOL is safe and effective for proliferative diabetic retinopathy, which may prevent a later second operation for post-vitrectomy cataract formation. During the surgery of pbacovitrectomy, protection of corneal endothelial cell and the reservation posterior capsule intact must be paid more attention to.

关 键 词：微创玻璃体切割术 超声乳化术 增生性糖尿病视网膜病 

分 类 号：R779.6[医药卫生—眼科]