玻璃体切除联合白内障超声乳化加人工晶状体植入治疗增殖性糖尿病视网膜病变

目的探讨玻璃体切除手术联合白内障超声乳化摘除加人工晶状体（IOL）植入术治疗增殖性糖尿病视网膜病变的效果。方法回顾分析32例（35眼）增殖性糖尿病视网膜病变玻璃体切除联合超声乳化加IOL植入手术患者资料，其中5期病变19眼，6期病变16眼。术前视力为光感～0．2，中位数为数指，仅5眼（14％）术前视力1〉0．1。均在局部麻醉下手术，白内障手术均先于玻璃体手术。术后随访时间I〉3个月。对数据进行分类计数，求百分比。结果IOL均成功植入囊袋内。15眼采用了硅油或长效气体填充。术中并发症包括：4眼（11％）瞳孔缩小，1眼（3％）囊袋内少许晶状体皮质残留。术后并发症包括：1眼（3％）复发玻璃体积血，4眼（11％）虹膜后黏连。末次随访视网膜均保持复位，术后视力0．01～0．6（中位数013），34眼（97％）术后视力1〉0．1。结论玻璃体切除联合白内障超声乳化摘除加IOL植入术是治疗增殖性糖尿病视网膜病变的有效手段。具有较高的安全性，有助于患者视力早期恢复。

Vitrectomy combined with phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy

Objective To investigate the outcome of vitrectomy combined with phacoemulsification and intraocular lens （IOL） implantation for proliferative diabetic retinopathy （PDR）. Methods A retrospective study of 35 eyes in 32 patients with PDR treated with vitrectomy combined with phacoemnlsification and IOL implantation was conducted. Stage V PDR was diagnosed in 19 eyes, and stage VI in 16 eyes. Preoperative visual acuity ranged from light perception to 0.2 （median, counting fingers）, visual acuity equal to or greater than 0.1 presented in only 5 eyes （14%）. All surgeries were performed under local anesthesia, with phacoemulsification prior to vitrectomy. The follow-up period was 3 months or more. Number was counted,and expressed with percentage. Results IOLs were implanted successfully into capsular bag. Silicone oil or long-acting gas was used in 15 eyes. Intraoperative complications included miosis in 4 eyes （11%） and a few intracapsular residues of the lens cortex in 1 eye （3%）. Postoperative complications included recurrent vitreous hemorrhage in 1 eye （3%） and iris posterior synechia in 4 eyes （11%）. The retina was still attached in all eyes at the final follow-up visit, with visual acuity ranging from 0.01 to 0.6 （median, 0.3）. Postoperative visual acuity equal to or greater than 0.1 was achieved in 34 eyes （97%）. Conclusion Vitrectomy combined with phacoemulsification and IOL implantation for the treatment of proliferative diabetic retinopathy is effective with better safety. Patients may benefit from an early visual recovery.