分析全玻璃体切除术联合超全视网膜光凝术治疗糖尿病性视网膜病变的效果及对视力恢复的影响  

Analyzing the effect of total vitrectomy combined with extra panretinal photocoagulation in the treatment of diabetic retinopathy and its impact on visual recovery

作　　者：要博[1] 冯炜 辛志坤[1] YAO Bo;FENG Wei;XIN Zhi-kun(Aviation General Hospital,Beijing 100107,China)

机构地区：[1]航空总医院,100107 [2]河北省眼科医院,054000

出　　处：《中国实用医药》2025年第7期28-32,共5页China Practical Medicine

摘　　要：目的分析全玻璃体切除术联合超全视网膜光凝术在糖尿病性视网膜病变(DR)中的应用价值。方法108例DR患者,以随机数字表法分为对照组及观察组,每组54例(54眼)。对照组患者接受全玻璃体切除术联合常规全视网膜光凝术,观察组患者接受全玻璃体切除术联合超全视网膜光凝术。对比两组最佳矫正视力(BCVA)、黄斑水肿情况、视网膜荧光造影结果及并发症发生率。结果与术后1周相比,两组术后1、3个月BCVA水平显著降低(P<0.05);两组各时间点BCVA水平比较,观察组低于对照组,但组间数据差异无统计学意义(P>0.05)。观察组黄斑水肿发生率为7.41%(4/54),低于对照组的16.67%(9/54),但组间数据差异无统计学意义(χ^(2)=2.186,P=0.139>0.05)。观察组黄斑水肿消失时间为(1.29±0.35)个月,显著短于对照组的(2.16±0.71)个月(t=2.289,P=0.043<0.05)。观察组视网膜无灌注区、视盘血管渗漏、视网膜血管渗漏、后极部出血点、后极部硬性渗出发生率分别为5.56%、1.85%、1.85%、5.56%、5.56%,低于对照组的18.52%、14.81%、12.96%、22.22%、20.37%(P<0.05)。观察组并发症发生率较对照组低,但组间数据差异无统计学意义(P>0.05)。结论全玻璃体切除术联合常规全视网膜光凝术或联合超全视网膜光凝术,均具有改善DR患者视力、降低黄斑水肿发生率的作用,但超全视网膜光凝术在缩短黄斑水肿消失时间、降低视网膜无灌注区、视盘血管渗漏、视网膜血管渗漏发生率等方面的疗效更加显著,同时也不增加术后并发症发生率,临床治疗安全性高。Objective To analyze the application value of total vitrectomy combined with extra panretinal photocoagulation in the treatment of diabetic retinopathy(DR).Methods 108 patients with DR were divided into control group and observation group by random numerical table,with 54 cases(54 eyes)in each group.The control group received total vitrectomy combined with conventional panretinal photocoagulation,and the observation group received total vitrectomy combined with extra panretinal photocoagulation.The best corrected visual acuity(BCVA),macular edema,retinal fluorescence angiography and complication rate were compared between the two groups.Results Compared with 1 week after surgery,BCVA levels in both groups were significantly decreased at 1 and 3 months after surgery(P<0.05).BCVA levels at each time point in the observation group was lower than those in the control group,but there was no statistical significance between the two groups(P>0.05).The incidence of macular edema in the observation group was 7.41%(4/54),which was lower than 16.67%(9/54)in the control group,but there was no significant difference between the two groups(χ^(2)=2.186,P=0.139>0.05).The disappearance time of macular edema in the observation group was(1.29±0.35)months,which was significantly shorter than(2.16±0.71)months in the control group(t=2.289,P=0.043<0.05).In the observation group,the incidence rates of non-perfusion area of retina,vascular leakage of optic disc,retinal vascular leakage,posterior polar bleeding point and posterior polar rigid exudation were 5.56%,1.85%,1.85%,5.56%and 5.56%,which were lower than 18.52%,14.81%,12.96%,22.22%and 20.37%in the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group,but there was no significant difference between the two groups(P>0.05).Conclusion Total vitrectomy combined with conventional panretinal photocoagulation or combined with extra panretinal photocoagulation can improve the visual acuity and reduce the incidence of macula

关 键 词：全玻璃体切除术 超全视网膜光凝术 糖尿病性视网膜病变 视力 黄斑水肿 

分 类 号：R779.6[医药卫生—眼科]