玻璃体手术治疗严重增生性糖尿病视网膜病变合并视网膜脱离的效果

目的探讨玻璃体手术治疗严重的增生性糖尿病视网膜病变合并视网膜脱离的疗效及影响视力预后的因素。设计回顾性病例系列。研究对象北京同仁医院2004年3月-2007年3月间行玻璃体手术治疗的87例(95眼)糖尿病视网膜病变Ⅵ期患者。方法回顾上述患者住院病历,均采用传统的三通道玻璃体手术治疗,术后平均随访时间26个月,观察术后视力及眼部并发症发生情况,分析影响视力预后的相关因素。主要指标视力及眼部并发症。结果术后83眼(87%)视网膜复位。视力较术前提高44眼(46.3%),不变16眼(16.8%),下降35眼(36.8%)。手术前后视力差异有统计学意义(P=0.012)。其中60眼视网膜脱离累及黄斑,术后45%的眼视力下降。术后继发新生血管性青光眼7眼(7.4%),角膜失代偿1眼(1.1%),晶状体混浊加重52眼(54.7%)。结论玻璃体切除术治疗严重的增生性糖尿病视网膜病变合并视网膜脱离是有效的,视网膜脱离是否累及黄斑是影响视力预后的最重要的因素。

Analysis of surgical outcomes of vitrectomy for severe proliferative diabetic retinopathy with retinal detachment

Objective To analyze surgical outcomes of vitrectomy for severe proliferative diabetic retinopathy （PDR） with retinal detachment. Design Retrospective case series. Participants 95 eyes of 87 patients with severe PDR stage VI, which underwent vitrectomy from March 2004 to March 2007. Methods The clinical data of 95 eyes of 87 patients with severe PDR were retrospectively analyzed. The mean follow up time was 26 months. The visual acuity and postoperative complications were recorded and the factors associated with visual acuity prognosis were analyzed. Main Outcome Measures The visual acuity and complications ＇after vitrectomy. Results The retina got anatomic reattachment in 83 eyes （87%）. The visual acuity after vitrectomy improved in 44 eyes （46.3%）, unchanged in 16 eyes （16.8%） and decreased in 35 eyes （36.8%）. The difference of visual acuity before and after surgery was statistically significant （P=0.012）. Retina detachment involved the macula in 60 eyes. Visual acuity decreased in 45% of these eyes after vitrectomy. After surgery, neovascular glaucoma happened in 7 eyes （7.4%）, corneal endothelium cell loss happened in 1 eye （1.1%）, and lens opacity progressed in 52 eyes （54.7%）, Conclusion Vitrectomy is effective for severe PDR with retinal detachment, and whether the retinal detachment involving the macula is the most important factor for visual acuity prognosis.