增生性糖尿病视网膜病变伴白内障的手术治疗  

The surgical management for proliferative diabetic retinopathy with cataract

作　　者：周林[1] 黄素英[2] 李芳芳[1] 

机构地区：[1]淮安市第二人民医院徐州医学院附属淮安医院眼科,江苏223002 [2]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼外伤职业眼病杂志》2017年第1期50-54,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的 探讨保留前囊的晶状体切除联合玻璃体切除及超广泛视网膜光凝（E-PRP）治疗增生性糖尿病视网膜病变（PDR）伴白内障的临床效果.方法 2010年1月至2013年6月收治的PDR伴白内障67例（70眼）,行保留前囊的晶状体切除联合玻璃体切除及E-PRP,均行硅油充填.术后随访12～ 25个月,观察眼压、视力、眼前段及眼后段情况.结果 术后58眼（82.86％）视力提高,12眼（17.14％）视力未提高.术后2眼（2.86％）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.术后出现一过性高眼压者15眼（21.43％）,虹膜后粘连4眼（5.71％）,前囊3级浑浊6眼（8.57％）.视网膜复位率为100％.硅油取出后发生视网膜脱离5眼,视网膜前增生膜形成8眼,重度黄斑水肿2眼,视神经萎缩2眼.最终59眼（84.29％）接受Ⅱ期人工晶状体植入术.结论 保留前囊的晶状体切除联合玻璃体切除及E-PRP治疗PDR是安全有效的,能维持前后房的正常生理屏障,减少术中及术后并发症,视力恢复较好.Objective To investigate the curative efficacy of vitrectomy and lensectomy preserving anterior lens capsule combined with extra-panretinal photocoagulation （E-PRP） for proliferative diabetic retinopathy （PDR） with cataract.Methods Total of 70 eyes of 67 patients who were suffered from PDR with cataract received treatment in our hospital from January 2010 to June 2013.All eyes were treated by vitrectomy and lensectomy preserving anterior lens capsule combined with E-PRP.Silicone oil tamponade was done in all eyes.The followed up time was 12-25 months.The intraocular pressure,visual acuity,eye anterior and posterior segment conditions were observed.Results Postoperatively the visual acuity improved in 58 eyes（82.86%） and unchanged in 12 eyes（17.14%）.Two eyes （2.86%） were found iris neovascuiarization （INV）and progressed to neovascular glaucoma,INV in 4 eyes gradually subsided.The postoperative complication incidence of transient high intraocular pressure,posterior synechia and 3 grade turbidity of anterior lens capsule was 21.43% （15 eyes）,5.71% （4 eyes） and 8.57% （6 eyes）.The rate of retinal reattachment was 100%.Five eyes suffered from recurrent retinal detachment after silicone oil removal.Epiretinal membranes formated in 8 eyes.Severe macular edema occurred in 2 eyes.Two eyes suffered from optic atrophy.Finally,59 eyes （84.29%） received secondary intraocular lens implantation.Conclusion Vitrectomy and lensectomy preserving anterior lens capsule combined with E-PRP is safe and effective for PDR with cataract.It can keep the normal physiological barrier between the anterior chamber and the posterior chamber,decrease the complications before and after the operation,and the visual acuity get good recovery.

关 键 词：玻璃体切除术 晶状体切除术 前囊 超广泛视网膜光凝术 糖尿病性视网膜病变 增生性 

分 类 号：R587.2[医药卫生—内分泌]