玻璃体切除术联合选择性视网膜光凝治疗糖尿病视网膜病变的效果  

Efficacy of vitrectomy combined with selective retinal photocoagulation for diabetic retinopathy

作　　者：郑春燕[1] 李秋明[1] 王梦华[1] 董洪涛[1] 董淑倩[1] 

机构地区：[1]郑州大学第一附属医院眼科,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2017年第6期428-432,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察玻璃体切除术（PPV）联合选择性视网膜光凝（SRP）治疗增生性糖尿病视网膜病变（PDR）合并玻璃体积血的效果。方法PDR合并玻璃体积血190例（200眼），均行23GPPV联合视网膜光凝，玻璃体内注射雷珠单抗（Lucentis）及曲安奈德。随机分为两组：术中行广泛视网膜光凝（panretinal photocoagulation，PRP）者为对照组（102例，108眼）；术中行SRP者为观察组（88例，92眼）。术后随访6个月，比较两组手术效果。结果术后1周、1个月及3个月观察组的BCVA均优于对照组，差异均有统计学意义（P=0．000），术后6个月两组间BCVA差异无统计学意义（P=0．094）；术后1周及1个月观察组黄斑中心区视网膜厚度（CMT）均低于对照组，差异均有统计学意义（P=0．000），术后3个月两组间CMT差异无统计学意义（P=0．349）。观察组补充视网膜光凝次数多于对照组，差异有统计学意义（P=0．000）。观察组复发性玻璃体积血发生率及新生血管性青光眼发生率虽较对照组稍高，但差异均无统计学意义（P=0．526，0．470）。结论对PDR伴玻璃体积血患者，在抗血管内皮生长因子（VEGF）药物及糖皮质激素类药物的辅助下，微创PPV联合SRP在减轻术后黄班水肿、提高术后早期视力方面效果优于微创PPV联合PRP治疗。Objective To observe the efficacy of pars plana vitrectomy （PPV） combined with selective retinal photocoagulation （SRP） in the treatment of proliferative diabetic retinopathy （PDR） with vitreous hemorrhage. Methods Two hundred eyes of 190 patients with PDR and vitreous hemorrhage were enrolled in this study. All patients were treated with 23-gauge PPV combined with retinal photocoagulation and intravitreal injection of Lucentis and triamcinolone aeetonide. All patients were divided randomly into two groups：the contral group, 108 eyes of 102 cases, received panretinal photocoagulation（PRP） during surgery and the observation group,92 eyes of 88 cases, received SRP during surgery. All patients were followed up for 6 months. The effect were compared between the two groups. Results BCVA of observation group was better than that of contral group at 1 week, 1 month and 3 months after surgery. The difference was statistically significant（ P = 0. 000）. The difference in BCVA was not statistically significant between the two groups at 6 months after surgery（ P = 0.094）. The central macular thickness（CMT） of observation group was lower than that of contral group at 1 week and 1 month after surgery, the difference was statistically significant （ P = 0. 000）. The difference was not statistically significant at 3 months after surgery between the two groups （P = 0. 349 ）. The number of times of retinal photocoagulation in observation group was more than that in contral group. The difference was statistically significant （ P = 0. 000 ）. The incidence of recurrent vitreous hemorrhage and neovascular glaucoma in observation group were higher than those in contral group. The difference were not statistically significant （P = 0. 526, 0. 470）. Conclusion Under the auxiliary of antivacular endothelial growth factor and triamcinoloneacetonide, microincision vitrectomy with SRP is better than microincision vitrectomy with PRP to treat patients with vitreous hemorrhage and PDR in reducing pos

关 键 词：视网膜病变 糖尿病性 增生性 玻璃体积血 玻璃体切除术 23G 光凝 视网膜 选择性 广泛 

分 类 号：R779.6[医药卫生—眼科]