内界膜部分剥除辅助玻璃体后脱离治疗增生性糖尿病性视网膜病变合并玻璃体积血的效果  

Efficacy of partial internal limiting membrane peeling assist posterior vitreous detachment for proliferative diabetic retinopathy with vitreous hemorrhage

作　　者：张竖[1] 程艳[1] 卢方琨 李大鹏 Zhang Shu;Cheng Yan;Lu Fangkun;Li Dapeng(Department of Ophthalmology,the Second Peoples Hospital of Lianyungang,Lianyungang 222000,China)

机构地区：[1]连云港市第二人民医院眼科,连云港222000

出　　处：《中华眼外伤职业眼病杂志》2023年第12期927-932,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的探讨玻璃体切除术中应用部分内界膜剥除辅助完成玻璃体后脱离治疗玻璃体与后极部视网膜粘连紧密的增生性糖尿病性视网膜病变(PDR)合并玻璃体积血的可行性。方法回顾性病例系列研究。纳入就诊于连云港市第二人民医院2021年1月至2022年12月PDR合并玻璃体积血30例(30眼),玻璃体切除术中应用黄斑区部分内界膜撕除辅助完成玻璃体后脱离。术后随访6个月,观察最佳矫正视力(BCVA,logMAR)、黄斑中心区厚度(CMT)及并发症发生情况。结果手术后1周,1、3及6个月BCVA分别为1.35±0.33、1.32±0.30、0.97±0.24、0.94±0.22。术后各时间点BCVA较术前(1.69±0.43)明显提高(均P<0.001);术后1周,1、3、6个月CMT分别为(296.77±36.76)、(291.50±32.69)、(255.57±23.96)、(252.73±24.44)μm。不同时间点CMT比较,差异有统计学意义(F=97.59,P<0.001)。BCVA和CMT在术后3个月趋于稳定。术后6个月出现并发黄斑前膜2眼(6.67%)、玻璃体积血1眼(3.33%)。结论对于玻璃体与后极部视网膜粘连紧密的PDR合并玻璃体积血患者,黄斑区部分内界膜剥除辅助完成玻璃体后脱离是可行的手术方法,术后BCVA及CMT均得到明显改善。Objective To investigate the feasibility of partial internal limiting membrane peeling assist posterior vitreous detachment in vitrectomy for PDR patients with vitreous hemorrhage of close vitreous adhesion to the posterior pole retina.Methods This was a retrospective case series study.Thirty eyes of 30 cases of diabetic retinopathy with vitreous hemorrhage who received vitrectomy combined with inner limiting membrane peeling in the Second People’s Hospital of Lianyungang from Jan.2021 to Dec.2022 were included.The best corrected visual acuity(BCVA,logMAR),central macular thickness(CMT),anterior macular membrane and other complications were compared during a 6-month follow-up postoperatively.Results BCVA at 1 week,1,3 and 6 months postoperatively was 1.35±0.33,1.32±0.30,0.97±0.24,0.94±0.22,respectively which significantly improved from preoperation(1.69±0.43)(all P<0.001).CMT at 1 week,1,3 and 6 months postoperatively was(296.77±36.76),(291.50±32.69),(255.57±23.96),(252.73±24.44)μm,respectively,the difference was statistically significant at different time points(F=97.59,P<0.001).BCVA and CMT plateaued at 3 months after surgery.Two eyes(6.67%)had epiretinal membrane,and 1 eye(3.33%)had vitreous hemorrhage.Conclusion For relative patients with proliferative diabetic retinopathy with vitreous hemorrhage of close vitreous adhesion to the posterior pole retina,part of internal limiting membrane peeling auxiliary posterior vitreous detachment is a feasible surgical method.BCVA and CMT significantly improve after surgery.

关 键 词：剥除 内界膜 脱离 玻璃体 后 视网膜病变 糖尿病性 

分 类 号：R779.6[医药卫生—眼科] R587.2[医药卫生—临床医学]