玻璃体视网膜手术联合激光光凝治疗增殖型糖尿病视网膜病变

目的观察玻璃体手术联合光凝治疗增殖型糖尿病视网膜病变(proliferativediabeticretinopathy,PDR)的疗效。方法对60例PDR患者(70只眼)行玻璃体手术联合激光光凝的治疗效果进行回顾性研究。结果60例PDR患者经过3～6个月随访,术后视力提高49只眼(70.00%),不变11只眼(15.71%),下降10只眼(14.26%)。3只眼术后视网膜再脱离,8只眼再次发生玻璃体积血。结论大多数PDR患者经玻璃体切除术联合激光光凝治疗后改善了视力。术前有效的视网膜光凝能提高手术治愈率。     

手术治疗增殖性糖尿病视网膜病变68例临床观察

目的:观察采用玻璃体切除术联合白内障切除术治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的疗效。方法:我院2008年6月至2010年6月采用玻璃体切除术联合白内障切除术治疗PDR患者68例共74眼,对患者手术前后视力状况和并发症等进行统计分析。结果:Ⅵ期患者的硅油填充率显著大于Ⅳ期和Ⅴ期患者(P<0.01);随访52例患者(71.27%)的视力得到了提升,Ⅳ期、Ⅴ期、Ⅵ期患者术后的视力增加率为100.00%、90.48%和61.22%;术后患者一次性视网膜复位成功率为100%。术后玻璃体出血1眼,术后后发性白内障8眼,填充硅油的患者有7眼出现高眼压,3眼出现硅油乳化。结论:玻璃体切除术联合白内障切除术可有效地对PDR进行治疗,改善患者的视力和减少再次白内障切除术的几率。     

玻璃体切割联合视网膜光凝治疗增生性糖尿病视网膜病变

目的 探讨玻璃体手术联合视网膜光凝治疗增生性糖尿病视网膜病(proliferative diabetic retinopathy,PDR)的临床效果.方法 对行玻璃体切割联合视网膜光凝治疗的21例(21眼)PDR病例进行回顾性研究.结果 术后随访2～23个月,手术后矫正视力提高18眼,脱盲率43.75%.结论 玻璃体切割联合视网膜光凝是治疗PDR的有效方法.PDR的病变情况在很大程度上决定了术后视力是否改善,故手术时机的合理选择尤为关键.     

玻璃体切除联合白内障手术治疗增殖性糖尿病视网膜病变

目的 评价玻璃体切除联合晶状体超声乳化及人工晶体植入术治疗增殖性糖尿病视网膜病变的临床效果.方法 回顾性分析25例(31眼)伴有白内障的增殖性糖尿病视网膜病变患者行玻璃体切除联合晶状体超声乳化及人工晶体植入术的临床资料,31眼同期植入后房型人工晶状体.结果 术后随访3-12个月,平均5.5个月.24眼(77.4%)术后视力改善.术中无并发症发生.术后并发症有:前房炎性反应5眼(16.1%),玻璃体积血2眼(6.5%),复发性视网膜脱离1眼(3.2%),新生血管性青光眼2眼(6.5%),14眼术后需要继续眼内光凝.结论 玻璃体切除联合晶状体超声乳化及人工晶体植入术治疗增殖性糖尿病视网膜病变,可使大多数患者的视力改善,手术是安全的.手术的关键为选择合适的患者.影响术后视力的主要因素为视网膜病变程度.     

增殖性糖尿病视网膜病变的手术时机探讨

目的 探讨增殖性糖尿病视网膜病变(PDR)的手术时机与疗效的关系.方法 对59例(65眼)PDR患者行玻璃体切除术,术中根据情况采用剥膜、视网膜光凝、气液交换或重水注入、C3F8气体或硅油眼内填充等方法,使网膜得到良好复位.结果 术后随访3～12月,术后矫正视力改善49眼(75.38%),视力不改善或下降16眼(24.62%,包括4眼视力丧失).其中Ⅳ-Ⅴ期视力改善39眼(84.78%),Ⅵ期10眼(52.63%).眼内填充硅油共27眼(41.54%),其中Ⅳ-Ⅴ期11眼(21.74%),Ⅵ期16眼(84.21%).结论 玻璃体切除能有效改善PDR患者视功能,Ⅳ-Ⅴ期患者视力改善明显好于Ⅵ期患者,合理掌握手术时机与适应证是治疗关键.     

玻璃体切割术治疗裂孔源性视网膜脱离

目的 评价玻璃体切割术治疗裂孔源性视网膜脱离的疗效.方法 回顾性分析67例67眼裂孔源性视网膜脱离经玻璃体切割术治疗后的疗效.结果 随访时间1～6年.视网膜复位66跟(98.5%),视力提高45眼(67.2%);一次手术视网膜复位60眼,增生性玻璃体视网膜病变导致的裂孔未闭和新裂孔形成是手术失败的主要原因,视力下降的原因是黄斑部病变.结论 玻璃体切割术是治疗裂孔源性视刚膜脱离的有效方法.     

玻璃体切除联合硅油填充并全视网膜激光光凝术治疗Ⅴ期糖尿病视网膜病变

目的 探讨玻璃体切除联合硅油填充并全视网膜激光光凝术治疗Ⅴ期糖尿病视网膜病变的临床效果。方法将2012年6月至2013年12月收治的前来就诊的增殖性糖尿病视网膜病变Ⅴ期的患者33例(50眼),行玻璃体切除全视网膜激光光凝术,术中根据玻璃体及视网膜增殖与牵拉情况,有无活动性出血决定是否填充硅油。观察与随访术后视力的恢复,术中、术后并发症的发生及患者的满意度。结果 16例(26眼)行玻璃体切除联合硅油填充并全视网膜激光光凝术治疗,17例(24眼)单纯行玻璃体切除及全视网膜激光光凝,未给予玻璃体填充硅油;所有患者手术均顺利,术后硅油填充者3眼出现眼压增高,经治疗,眼压于1周后控制并平稳;无硅油填充者6眼再次发生出血,造成玻璃体积血;术后12个月内,无硅油填充者4眼发生视网膜脱离;在视力恢复及患者满意度上,有硅油填充者视力较术前提高者较多,患者满意率也较高。结论 玻璃体切除联合硅油填充并全视网膜激光光凝术治疗治疗Ⅴ期糖尿病视网膜病变安全有效,可降低术后再出血及视网膜脱离的发生。     

玻璃体切割术对增生性糖尿病视网膜病变患者的视力及并发症的影响

目的探讨玻璃体切割术对增生性糖尿病视网膜病变患者的视力及并发症的影响。方法选择2013年1月~2014年1月在我院行玻璃体切割术治疗的PDR患者50例患者作为研究对象,PDR分期:Ⅳ期30眼,V期14眼,Ⅵ期6眼。所有入选患者均同意参加本研究并签署知情同意书。结果术后视力较术前提高36眼(72.0%),视力不变10眼(20.0%),4眼(8.0%)视力下降。50例患者术后眼压、黄斑中心凹视网膜厚度均较术前显著降低,差异具有高度统计学意义(P0.01)。术中出血20眼,经提高灌注瓶高度和(或)眼内电凝后止血。术后再出血3眼、保守治疗后出血吸收。PDR V期术中剥膜形成医源性裂孔3只眼,1眼术后3个月出现视网膜再脱离,而再次行玻璃体切割术。结论玻璃体切割术是治疗增生性糖尿病视网膜病变、改善患者视功能的有效方法之一,且并发症少,住院时间短,值得推广和应用。     

增殖性糖尿病视网膜病变玻璃体视网膜手术后玻璃体出血的治疗体会

目的探讨增殖性糖尿病视网膜病变(PDR)玻璃体视网膜手术后严重玻璃体出血的原因、并发症及处理方法。方法对我院2002年1月至2004年3月住院行玻璃体视网膜手术治疗PDR的112例患者中术后发生严重玻璃体出血的18例(18只眼)患者进行回顾性分析。结果术后玻璃体出血中49％出现于术后第1天，出血原因包括纤维血管膜残端出血、视网膜新生血管膜渗血、视网膜切开、视网膜裂孔、前玻璃体纤维血管增殖等；出血并发症包括继发性青光眼、增殖膜形成等。结论PDR玻璃体切割术后玻璃体出血为术后常见的并发症；对于出血量大，难于吸收及出现并发症的病例，积极治疗可改善视力预后。     

增殖性糖尿病视网膜病变玻璃体切割手术分析

增殖性糖尿病视网膜病变(proliferative diabetic retinopalhy，PDR)合并玻璃体积血或视网膜脱离，需手术清除PDR引起的玻璃体混浊，松解玻璃体对视网膜的牵拉。现对我院自2000年以来对随诊的28例31只眼的手术结果、并发症进行分析。     

增生前期糖尿病性视网膜病变的光凝固治疗

目的　观察增生前期糖尿病性视网膜病变激光治疗效果。方法　采用美国产 Utim a2 0 0 0 SE型氩离子激光器 ,对 82例 92眼增生前期糖尿病性视网膜病变行全视网膜光凝。结果　经 1～ 5 a的观察 :1治疗后≤ 0 .1的眼数减少 6眼 ,0 .2～ 0 .4的眼数减少 19眼 ,0 .5～ 0 .9的眼数增加了 2 0眼 ,≥ 1.0的眼数增加了 5眼。 216眼发展成增生型糖尿病性视网膜病变 ,其中 4眼发生视乳头新生血管 ,12眼发生视网膜新生血管 ,7眼伴有玻璃体出血 ,2眼行玻璃体切割手术。结论　增生前期行全视网膜光凝是最合适的时机 ,可阻止和延缓糖尿病性视网膜病的发展     

多波长氪激光治疗糖尿病视网膜病变的疗效观察

目的：观察多波长氪离子激光对糖尿病视网膜病变（diabetic retinopathy,DR）的疗效。方法：根据DRPSG（Diabetic Retinopathy Photocoagulation Study Group）制订的治疗技术规定,采用多波长氪离子激光对160例283眼[分别为增殖前期糖尿病视网膜病变（PPDR）、增殖期糖尿病视网膜病变（PDR）]行全视网膜光凝治疗（PRP）,根据病变性质、部位和屈光间质情况选择不同波长激光进行视网膜光凝。术前行视力、裂隙灯、检眼镜、眼压、眼B型超声、视野和荧光素眼底血管造影检查,术后随访6～24个月。结果：PPDR视力提高和不变占75眼（78.11%）,PDR视力提高和不变占153眼（81.18%）,其间未见严重并发症。结论：用多波长氪离子激光治疗DR操作方便,使部分患者视力提高,是治疗DR的有效方法,可依实际需要组合使用不同波长治疗糖尿病视网膜病变,扩大了治疗DR的适应证。     

玻璃体手术治疗增生性糖尿病视网膜病变39例

目的观察玻璃体手术治疗增生性糖尿病视网膜病变的疗效及并发症。方法回顾性分析39例（61眼）增生性糖尿病视网膜病变患者行玻璃体视网膜手术的临床资料。随访10-24个月,平均随访时间13．5个月。结果术后视力提高51眼（83．61％）,视力不变8眼（13．11％）,视力下降2眼（3．28％）。术前视力光感42眼,指数～0．0213眼,0．03～0．056眼。术后视力无光感1眼,光感2眼,指数～0．025眼,0．03～0．058眼,0．06～0．111眼,0．12～0．318眼,0．3以上16跟。并发症主要为术中出血和医源性视网膜裂孔。结论玻璃体手术治疗增生性糖尿病视网膜病变疗效佳,并发症少。     

半导体532激光治疗糖尿病视网膜病变的临床观察

目的：观察半导体532激光光凝术治疗糖尿病视网膜病变（ DR）的临床疗效。方法采用半导体532激光对50例（95只眼）非增殖性和增殖性DR患者进行局限性视网膜光凝、格栅样视网膜光凝或全视网膜光凝治疗。观察治疗前后视力、裂隙灯、眼底、眼压、眼底血管荧光造影及眼底OCT的变化,光凝术后随访6个月。结果光凝术后36眼（37．9％）视力提高,视力无变化52眼（54．7％）,视力下降7眼（7．4％）,总有效88眼（92．6％）。伴黄斑水肿者26眼,经光凝后黄斑水肿完全或部分消退,未出现新的黄斑水肿。结论半导体532激光光凝术治疗DR安全有效。     

术前注射雷珠单抗辅助治疗增生型糖尿病视网膜病变的临床效果

目的 观察分析术前玻璃体腔注射雷珠单抗辅助23G玻璃体切割术治疗增生性糖尿病视网膜病变患者的临床效果.方法 选择2014年1月至2016年9月本院眼科收治的行23G玻璃体切割术治疗的增生性糖尿病视网膜病变患者126例,随机分为对照组和观察组,每组63例,对照组采用23G玻璃体切割手术治疗,观察组在术前7d玻璃体内注射雷珠单抗,比较两组手术时间、术中出血率、医源性视网膜裂孔发生率以及术中填充物使用率,对所有患者随访2个月,比较两组术后2个月视力、玻璃体腔再增生以及出血的发生率.结果与对照组比较,观察组手术时间、术中出血率、医源性视网膜裂孔发生率均显著减少(P＜0.05),观察组术中填充硅油(SO)明显少于对照组,填充平衡盐溶液(BSS)明显多于对照组(P＜0.05);两组术中填充气体(C3F8)之间比较差异无统计学意义(P＞0.05).术后随访2个月,观察组玻璃体腔再增生以及出血的发生率均显著低于对照组(均P＜ 0.05),两组术后2个月视力之间比较差异无统计学意义(P＞0.05).结论 增生性糖尿病视网膜病变患者行23G玻璃体切割术前玻璃体内注射雷珠单抗可以缩短手术时间,减少术后出血,患者的视力得到显著的提高.     

Retrospective analysis of rosiglitazone and macular oedema in patients with type 2 diabetes mellitus

BACKGROUND: Macular oedema tends to be a more rapid complication of diabetic retinopathy and represents the major cause of blindness. Among subjects with type 2 diabetes mellitus, it can be found in 15% of those who use insulin and 4% of those who do not. Use of thiazolidinediones (glitazones) has recently been associated with some cases of macular oedema. METHODS: We recalled 102 diabetic subjects treated with rosiglitazone to our diabetes centre in order to evaluate a possible association of this drug with macular oedema. Of these 102 subjects, we evaluated all 76 who provided written informed consent to participate in the analysis. All of these underwent a battery of four diagnostic tests: (1) visual acuity, (2) Amsler visual field test, (3) Ishihara colour recognition test, and (4) retinal fundus photography. All retinal photographs were examined by two experienced ophthalmologists. RESULTS: The most noticeable result was that most subjects (80%) had satisfactory visual acuity. The Ishihara test chart showed that three subjects were colour blind, but this abnormality was already known. On the Amsler test, one subject had a positive result consisting of visual distortion of a series of straight lines. In the retinal photos, two expert ophthalmologists independently identified one case of 'paramacular oedema' in a subject with diabetes of long duration with a proliferative retinopathy. The patient developed bilateral macular oedema during treatment with rosiglitazone 8 mg/day. The patient had been diagnosed with diabetes at the age of 45 years and after a period of 6 years taking oral antihyperglycaemic agents had been switched to insulin, up to four injections per day (total 60-70 IU/day), for the next 15 years. In 2000 a routine examination demonstrated the presence of sustained hypertension and the patient was started on an ACE inhibitor. A computerized test for autonomic neuropathy demonstrated abnormal deep breathing and lying-to-standing responses. Treatment with rosiglitazone was interrupted and the subject underwent a series of retinal photocoagulations for proliferative retinopathy. Two months after rosiglitazone therapy had been discontinued, the visual acuity of the patient reversed to baseline values. CONCLUSION: The study shows that rosiglitazone was not linked to formation of macular oedema, with the exception of one case of bilateral and clinically reversible paramacular oedema, where rosiglitazone was given in co-administration with a long-term insulin treatment regimen in a subject with pre-existing diabetic retinopathy. This patient had a long duration of diabetes and had also been hypertensive since 2000.     

Fibrates and statins in the treatment of diabetic retinopathy

Diabetic retinopathy (DR) is one of the leading risk factors and causes of blindness worldwide. Tight glucose and blood pressure control has been shown to significantly decrease the risk of development as well as the progression of retinopathy and represents the cornerstone of medical management of DR. The two most threatening complications of DR are diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Photocoagulation is standard treatment for both DME and PDR. However, some patients suffer permanent visual loss despite therapy. Treatment with fibrates first showed reduction in hard exudates, an effect subsequently shown with statins in short term studies, in particular two randomized studies in patients with macular edema. In the FIELD study which pre-specified microvascular outcomes, fenofibrate reduced laser treatment for DME or PDR by 31%:164 (3.4%) patients on fenofibrate vs. 238 (4.9%) on placebo (p<0.001). In the ophthalmology sub-study of FIELD, the composite exploratory endpoint of 2-step progression of ETDRS retinopathy grade, macular edema or laser treatment was significantly reduced by 34%: 53 (11.1%) patients on fenofibrate vs. 75 (16.1%) on placebo (p=0.022). Conversely, there was no reduction in laser treatment or reduced progression of retinopathy in two large scale studies of statins where cardiovascular events were significantly reduced. Neither class of lipid-lowering drugs consistently improved visual acuity. In the ACCORD-EYE study, the combination of fenofibrate and simvastatin reduced by 40% the rate of progression of diabetic retinopathy compared with simvastatin alone. Other studies are needed to establish the place of lipid lowering drugs in the treatment of macular edema and the prevention of vision loss.     

手法小切口白内障手术治疗糖尿病性白内障的疗效分析

目的分析手法小切口白内障摘除联合人工晶状体植入术治疗糖尿病性白内障的疗效。方法对68例(96眼)糖尿病合并白内障的患者行小切口白内障摘除及人工晶状体植入术的临床资料进行回顾性分析。统计术后1、30d的视力,术后视力与糖尿病病程的关系以及术后并发症。结果术后第1天裸眼视力>0.5者69眼(71.88%),0.3～0.5者18眼(18.75%),0.1～0.25者6眼(6.25%),<0.1者3眼(3.13%);术后第30天裸眼视力>0.5者74眼(77.08),0.3～0.5者16眼(16.67%),0.1～0.25者4眼(4.17%),<0.1者2眼(2.08%)。术后并发症主要有角膜水肿、前房纤维素性渗出、虹膜粘连、继发青光眼。结论手法小切口白内障摘除联合人工晶状体植入术治疗糖尿病性白内障是安全有效的,术后视力的恢复与糖尿病病程及糖尿病视网膜病变有关。     

糖尿病视网膜病变眼底出血应用云南白药胶囊治疗的疗效及不良反应分析

目的分析糖尿病视网膜病变眼底出血应用云南白药胶囊治疗的疗效及不良反应。方法135例糖尿病视网膜病变眼底出血患者,采用数字随机分组的方式分为对照组(67例)和观察组(68例)。对照组患者均接受银杏达莫注射液治疗,观察组患者给予云南白药胶囊治疗。比较两组患者不良反应发生情况、视力情况以及临床疗效。结果观察组皮疹发生率0、轻度头痛发生率0、恶心呕吐发生率2.94%和谷丙转氨酶(ALT)升高发生率5.88%均明显低于对照组的7.46%、16.42%、14.93%、17.91%,差异均具有统计学意义(P<0.05)。两组患者的腹泻发生率比较,差异均无统计学意义(P>0.05)。观察组患者治疗后视力<0.3为9例(13.24%),视力0.3~0.5为15例(22.06%),视力>0.5为44例(64.71%);对照组患者治疗后视力<0.3为12例(17.91%),视力0.3~0.5为16例(23.88%),视力>0.5为39例(58.21%),两组患者视力情况比较,差异无统计学意义(P>0.05)。观察组治疗总有效率89.71%与对照组的86.57%比较,差异无统计学意义(P>0.05)。结论糖尿病视网膜病变眼底出血应用云南白药胶囊治疗的疗效可观且安全性高,值得进一步推广实施。     

Ranibizumab and diabetic macular oedema: after laser therapy

Diabetic retinopathy is sometimes accompanied by macular oedema, leading to a marked decline in visual acuity. The standard treatment, in addition to glycaemic and blood pressure control, is laser photocoagulation, despite its modest efficacy. Ranibizumab (Lucentis, Novartis), a VEGF (vascular endothelial growth factor) inhibitor, was initially authorised for age-related macular degeneration (AMD) in the European Union. It is now also approved for the treatment of visual loss due to macular oedema in diabetic patients. In this setting, clinical evaluation of ranibizumab is mainly based on two double-blind randomised trials comparing ranibizumab + laser photocoagulation versus placebo + laser photo-coagulation in a total of about 1000 patients. Compared with placebo, addition of ranibizumab to laser therapy led to a marked improvement in visual acuity in approximately 15% of patients after 12 months of treatment. The improvement appeared to persist after 24 months of treatment. In a trial that included a group treated with ranibizumab alone, efficacy did not differ from that of the ranibizumab + laser combination. Uncertainties remain concerning the long-term efficacy of ranibizumab and its benefits in patients with poorly controlled diabetes or proliferative retinopathy. The adverse effect profile of ranibizumab in patients with diabetic macular oedema is similar to that reported in patients with AMD, and mainly includes ocular adverse effects such as pain, bleeding and increased intraocular pressure. A risk of systemic adverse effects, particularly cardiovascular disorders, should be kept in mind in case of long-term treatment. Ranibizumab can cause birth defects, even after intravitreal injection during pregnancy. Monthly treatment with ranibizumab is inconvenient, difficult and expensive. In practice, laser therapy remains the standard treatment for diabetic patients with significantly reduced visual acuity due to macular oedema. Ranibizumab, which requires intravitreal injections, should be restricted to second-line use.