玻璃体切除术治疗慢性肾衰竭患者增生性糖尿病视网膜病变  

Clinical efficacy of vitrectomy for proliferative diabetic retinopathy in patients with chronic renal failure

作　　者：黄冠南[1] 苏龙[1] Huang Guannan;Su Long(Department of Ophthalmology, the 2nd Hospital of Tianjin Medical University, Tianjin 300211, China)

机构地区：[1]天津医科大学第二医院眼科,天津300211

出　　处：《中华眼外伤职业眼病杂志》2018年第5期333-336,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评价玻璃体切除术治疗慢性肾衰竭患者增生性糖尿病视网膜病变的临床效果。方法回顾性分析慢性肾衰竭患者增生性糖尿病视网膜病变行玻璃体切除术21例（21只眼）的临床资料。结果术后随访3个月，末次随访最佳矫正视力较术前提高者20只眼（95．24％），下降者1只眼（4．76％）。术后最佳矫正视力（logMAR）术前平均为2．05±0．78，末次随访平均为0．68±0．66，较术前明显提高，差异有统计学意义（t=6．103，P=0．000）。围手术期18例血压升高，三通道建立后17例血压升高，术中11例血压反复升高，均给予相应处理后完成手术。术中清除玻璃体积血及增生膜，视网膜复位。术后并发症：短暂眼压升高3只眼，少量视网膜前出血4只眼，缺血性视神经改变3只眼，血液透析静脉置管后真菌眼内炎1只眼，呼吸道感染心力衰竭1只眼。结论围手术期合理处理的前提下，微创玻璃体切除术可有效治疗肾衰竭患者的增生性糖尿病视网膜病变，提高视力，改善生活质量。ObjectiveTo evaluate the efficacy of vitrectomy for the treatment of proliferative diabetic retinopathy in patients with chronic renal failure.MethodsClinical data of 21 eyes of 21 cases with chronic renal failure and proliferative diabetic retinopathy were analyzed retrospectively. All cases underwent vitrectomy.ResultsThe follow-up time was 3 months. The postoperative BCVA were improved in 20 eyes （95.24%）, and decreased in 1 eye （4.76%）. The average BCVA（logMAR） was 2.05±0.78 before operation and 0.68±0.66 after operation. The difference in BCVA was statistically significant between pre-operation and post-operation （t=6.103, P=0.000）. During perioperative period blood pressure was elevated in 18 patients. Blood pressure was increased after establishment of the three scleral cannulas in 17 patients. The increase of blood pressure repeatedly occurred in 11 patients during operation. All patients with high blood pressure were treated with appropriate treatment. All the proliferative membrane and vitreous hemorrhage were removed, retina was reattached. The postoperative complications included temporary intraocular pressure elevation in 3 eyes, pre-retinal hemorrhage in 4 eyes, ischemic optic neueopathy in 3 eyes, endogenous fungal endophthalmitis after hemodialysis deep vein catheterization in 1 eye, and heart failure caused by respiratory tract infection in 1 eye.ConclusionCarefully conducted perioperative treatment and relatively stable systemic conditions, a well-designed minimally invasive vitrectomy can effectively treat proliferative diabetic retinopathy in patients with chronic renal failure, improving visual acuity and quality of life.

关 键 词：玻璃体切除术 肾功能衰竭 慢性 视网膜病变 糖尿病性 增生性 

分 类 号：R587.2[医药卫生—内分泌]