增殖期糖尿病视网膜病变伴牵拉性视网膜脱离患者新生血管膜分布特点的临床研究  

Clinical study on distribution characteristics of neovascularization in patients with proliferative diabetic retinopathy and tractional retinal detachment

作　　者：李思佳[1] 顾永昊[1] 柯根杰[1] 

机构地区：[1]安徽医科大学附属安徽省立医院眼科,230001

出　　处：《实用防盲技术》2017年第2期78-81,F0003,共5页Journal of Practical Preventing Blind

摘　　要：目的探讨增殖期糖尿病视网膜病变(PDR)伴牵拉性视网膜脱离的患者新生血管膜分布及粘连特点。方法本研究收集2015年11月-2017年01月于安徽省立医院眼科住院诊断增殖期糖尿病视网膜病变(PDR)合并牵拉性视网膜脱离明确的54例54只眼。于玻切手术术中,根据视盘部是否覆盖新生血管膜、临床分区、象限分区三个指标分别记录新生血管膜位置。记录新生血管膜面积、新生血管膜在视盘部及眼底象限分区有无粘连。记录随访至术后6个月的术眼的最佳矫正视力(BCVA)及网膜复位情况。结果视盘部新生血管膜发病率约为72.2%。按照临床分区,新生血管膜的分布为后极部分布较多,占70.4%。按照象限分区,新生血管膜在鼻上方、鼻下方分布较多,分别为57.4%和55.6%。在合并有视盘部新生血管膜39例39眼中,与视盘部有粘连占30.8%。新生血管膜粘连在鼻上方及鼻下方较多,分别为55.6%和50.0%。随访至术后6个月,术后平均BCVA较术前平均BCVA提高,差异具有统计学意义(Z=-5.470,P<0.05)。视网膜复位率是87.0%。结论糖尿病视网膜病变(DR)患者中,合并视盘部新生血管膜发病率高。新生血管膜大部分集中在视网膜后部眼底及鼻侧。新生血管膜主要在鼻侧、视盘部粘连较多且牢固,粘连一般位于视网膜血管处。玻切手术可以改善患者的视力预后,网膜复位率也可以达到87.0%。Objetive To investigate the distribution and adhesion of neovascularization in patients with diabetic retinopathy （PDR） and tractional retinal detachment. Methods In this study, 54 cases （54 eyes） with retinal detachment from diabetic retinopathy （PDR） with retinal detachment were diagnosed in the Department of Ophthalmology, Anhui Provincial Hospital from November 2015 to January 2017. During the vitrectomy, whether the optic disc is covered with neovascularization, the total area of neovascularization membrane ,neovascularization membrane ＇s division, quadrant partition and adhesion to retina were recorded. The best corrected visual acuity （BCVA） and retina attachment after the surgery were analzed. Results The incidence of neovascularization over optic disc was 72.2% . According to the clinical division, the distribution of neovascularization membrane at posterior area account for 70.4%. According to the quadrant, the neovascularization membrane was distributed often at superior nasal side and inferior nasal side, which was 57.4% and 55.6%, respectively. In the 39 eyes of neovascnlarization over optic disc, 12 cases （12.8%） were adhered tightly to the optic disc. Neonatal vascular adhesions at the superior nasal side and inferior nasal side were in 55.6% and 50.0% of all cases, respectively. The mean BCVA was significantly higher than that before operation （Z = -5.470, P〈O.05）. The retinal reattachment rate was 87.0%.Conclusion Diabetic retinopathy（DR） patients, combined with optic disc neovascularization rate is high, and prone to adhesion. In surgery, it should be stripped as much as possible. According to the clinical division, the neovascularization membrane is mostly concentrated in the posterior of the retina, can be extended to the equator. According to the quadrant, neovascularization located more in the nasal retina. Adhesions are generally located in the retinal blood vessels. Vitrectomy can improve the patient＇s vision prognosis and retinal attachment rate can reach

关 键 词：增殖期糖尿病视网膜病变 牵拉性视网膜脱离 新生血管膜 分布特点 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]