超声乳化人工晶状体植人联合玻璃体切除术治疗增生型糖尿病视网膜病变

目的评价晶状体超声乳化、囊袋内人工晶状体植入联合玻璃体切除术治疗增生型糖尿病视网膜病变（PDR）的临床效果。方法回顾性分析合并不同程度白内障的增生型糖尿病视网膜病变6l例（66眼）。其中PDRlV期20眼，V期33眼，Ⅵ期13眼。实施晶状体超声乳化、囊袋内人工晶状体植人联合玻璃体切除术。观察术后视力改善程度和术中术后并发症。结果术后视力改善：PDR1V期19眼（95．0％），V期28眼（84．8％），Ⅵ期13眼（38．5％）。术后视力低下者多伴有明显的糖尿病黄斑病变。术中术后主要并发症包括：医源性裂孔7眼（10．6％）；玻璃体积血，术中17眼（25．8％），术后7眼（10．6％）；角膜上皮延期愈合9眼（13．6％）；角膜水肿8眼（12．1％）。结论超声乳化、人工品状体植入联合玻璃体切除术治疗合并不同程度白内障的增生型糖尿病视网膜病变是安全有效的，可使大多数患者视力改善，避免玻切术后并发白内障再次手术。糖尿病黄斑病变是影响术后视力提高的主要原因。

Phacoemulsification and intraocular lens implanted combined with vitrectomy to treat hyperplasia diabetic retinopathy

Objective To evaluate the outcome of combined phacoemulsification, in-the-bag implantation of posterior chamber intraocular lens( PCIOL) ,and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. Methods This retrospectiive study consisted of 66 eyes of 61 patients with proliferative diabetic retinopathy and clinically significant lens opacities ( Among them, Ⅳ PDR 20 eyes, Ⅴ PDR 33 eyes, Ⅵ PDR 13 eyes). Phacoemulsification and intraocular lens implantation was combined with pars plana vitrectomy. Postoperative visual acuity, and complications were analyzed. Results The Postoperative visual acuity improved : Ⅳ PDR 19 eyes (95% ) , Ⅴ PDR 28 eye (84.8% )s,Ⅵ PDR 13 eyes (38.5% ). Diabetic macular abnormalities present to eyes with low visual acuity. Postoperative major complications included; introgenic tetinal hole occurred in 7eyes ( 10. 6% ) ; intraoperative vitreous hemorrhage in 17eyes(25. 8% ) postoperative vitreous hemorrhage in 7eyes( 10. 6% ) ;delayed corneal epithelial healing in 9 eyes( 13. 6% ) ;corneal edema in 8eyes( 12. 1% ). Conclusions This study suggests that the combined operation of Phaco and IOL implantation, PPV is safe and effective for PDR coexisting with cataract. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation. Diabetic macular abnormalities is main reason preventing visual acuity raising.