增生性糖尿病视网膜病变玻璃体切除硅油或全氟丙烷填充术

目的观察增生性糖尿病视网膜病变（PDR）玻璃体切除术后填充硅油或C3F8的临床效果。方法对本科2010年6月至2011年12月,PDR60例（77眼）行玻璃体切除手术。分硅油填充组和C3F8填充组,两组患者年龄、性别、病程的差异均无统计学意义（P〉0．05）。术后随访视力、眼压、视网膜、视神经变化。结果硅油填充组手术前后视力进行比较,差异有统计学意义（x^2=10．31,P〈0．05）,C3F8填充组手术前后视力进行比较,差异有统计学意义（x^2=9．20,P〈0．05）。两组间手术后视力进行比较差异有统计学意义（x^2=9．01,P〈0．05）。硅油组与C3F8组术后眼压进行比较差异有统计学意义（Z=-3．50,P〈0．05）。硅油组41眼中视盘颜色苍白5眼（12．20％）,视盘色淡3眼（7．32％）,视网膜局部血管闭塞10眼（24．39％）;未发现视网膜再出血或脱离。C3F8填充组36眼术后气体全部吸收,视盘色淡3眼（8．33％）,未发现有视盘色苍白或视网膜局部血管闭塞,视网膜再次出血5眼（13．88％）,视网膜再次脱离2眼（5．55％）。结论PDR行玻璃体切除硅油填充术后效果良好,只有少数患者出现眼压难以控制,最终导致视功能损害。C3F8填充术后没有出现视网膜脱离及再出血者的视功能恢复要好于硅油填充组。所以PDR行玻璃体切除手术后应根据视网膜情况选择合适的玻璃体填充物,填充硅油的患者应在视网膜复位后尽早的取出眼内硅油,避免对视神经、视网膜造成不可逆性损害。     

重硅油填充治疗极重度增生性玻璃体视网膜病变

目的:研究玻璃体切割联合重硅油填充治疗极重度增生性玻璃体视网膜病变(proliferative vitreous retinopathy,PVR)的临床疗效. 方法:回顾性筛选2012-06/2015-12我科收治的极重度PVR患者13例13眼,分析对其行玻璃体切割联合重硅油填充术及后期重硅油取出联合C3F8填充术的临床疗效.13眼于重硅油填充术后10~17wk行重硅油取出联合C3F8填充术.13眼观察随访时间为玻璃体切割联合重硅油填充术后第1~7d、出院后1、2、4~17wk,重硅油取出术后第 1~7d、出院后1、2、4、8、12、24wk复查,取油术后随诊时间不少于24wk.观察指标包括视网膜复位、最佳矫正视力、眼压、人工晶状体及并发症等.结果:患者13眼于重硅油填充术后随诊期间,下方裂孔均封闭、视网膜均平复;13眼分别于重硅油填充术后10~17wk行重硅油取出联合C3F8填充术,其中第5例患者于取油术后4wk因黄斑裂孔再次视网膜脱离,第8例患者于取油术后8wk因颞上方新的裂孔再次视网膜脱离,余11眼于取油术后随诊24wk,下方视网膜裂孔均封闭、视网膜平复.患者13眼于重硅油填充术前最佳矫正视力为光感~手动,于重硅油取出术后24wk随诊时最佳矫正视力为手动~20/250,其中重硅油取出术后再出现视网膜脱离的第5例及第8例患者于末次随诊时视力为指数和手动.4眼于重硅油填充术后1wk内出现高眼压,经抗炎和降眼压药物治疗后,眼压降至10~21mmHg,后期因重硅油乳化5眼出现药物难以控制的高眼压,对其及时行重硅油取出术,取油术后3眼曾出现一过性高眼压,经降眼压药物治疗后控制在10~21mmHg,后期3眼停用降眼压药物未再出现眼压升高情况.13眼于治疗期间未出现严重前房炎症反应、眼内炎等并发症.结论:对极重度PVR行玻璃体切割联合重硅油填充及后期重硅油取出联合C3F8填充术,可获得满意的视网膜复位率,并最大限度地提高患者的预后视力.     

Use of viscodissection and silicone oil in vitrectomy for severe diabetic retinopathy

Improvement in surgical techniques has led to improved anatomic and functional success rates following surgery for severe complications of proliferative diabetic retinopathy (PDR). We compared the anatomic and functional outcomes of surgery in a non-randomized, consecutive case series of patients with severe PDR. We found that viscodissection using Healon provides outcomes comparable to conventional pick and scissors dissection. We also found that adjunctive use of silicone oil can salvage selected cases with particularly severe manifestations of PDR (e.g., the fibrinoid syndrome). With proper selection of patients and techniques, the anatomic success rate can exceed 80% even in the most severe cases. The goal of this paper is to show the applicability of using viscodissection and silicone oil infusion during vitrectomy in eyes with severe PDR.     

Use of viscodissection and silicone oil in vitrectomy for severe diabetic retinopathy

Improvement in surgical techniques has led to improved anatomic and functional success rates following surgery for severe complications of proliferative diabetic retinopathy (PDR). We compared the anatomic and functional outcomes of surgery in a non-randomized, consecutive case series of patients with severe PDR. We found that viscodissection using Healon® provides outcomes comparable to conventional pick and scissors dissection. We also found that adjunctive use of silicone oil can salvage selected cases with particularly severe manifestations of PDR (e.g., the fibrinoid syndrome). With proper selection of patients and techniques, the anatomic success rate can exceed 80% even in the most severe cases. The goal of this paper is to show the applicability of using viscodissection and silicone oil infusion during vitrectomy in eyes with severe PDR.     

Does silicone oil improve the prognosis of severe proliferative diabetic retinopathy?

We report on a series of 135 consecutive cases of pars plana vitrectomy for proliferative diabetic retinopathy (average period of observation was 13 months). BSS was used in 69 eyes and silicone oil was used in 66 eyes as a vitreous substitute, the indications for silicone oil in these cases were the presence of several retinotomies or retinectomies as well as sharply increased risk for rebleeding. Postoperatively and after a minimum follow up of 6 months (55 eyes) the two groups with BSS or silicone oil achieved comparable functional results despite the different anatomical preoperative situation. Thus 18 out of 23 eyes of the silicone oil group, originally with detached macula and visual acuity of HM or FC, achieved a visual outcome of greater than = 0.02, showing the best postoperative result. In the BSS-group, with attached macula prior to the operation and same visual acuity, this result is attained by 27 out of 35 eyes. We interpret these figures as meaning, that silicone oil in proliferative diabetic retinopathy reduces some of the problems connected with more advanced retinal changes like retinal detachment and rebleeding thereby allowing a visual outcome which corresponds to the macular condition.     

DR硅油填充后并发白内障行超声乳化联合硅油取出

目的：探讨糖尿病视网膜病变硅油填充后并发白内障的超声乳化及人工晶状体（IOL）植入联合硅油取出术的临床疗效。 方法：糖尿病视网膜病变患者22例22眼硅油填充后并发白内障行超声乳化及IOL植入联合硅油取出术,均通过角膜透明切口植入软性IOL。 结果：患者19眼视力均在白内障超声乳化手术后视力较术前提高,其中0.1以上者13例,3例同术前视力;手术中后囊膜保持完整,均顺利植入软性可折叠IOL;5例术后不同程度发生角膜水肿,均在术后3~7d内消退。22例硅油均顺利取出。3例术后1mo内发现玻璃体腔积血,其中2例约4wk内玻璃体腔积血自行吸收,1例再行玻璃体手术去除积血联合眼内光凝。22例术后均未发现视网膜再脱离。 结论：糖尿病视网膜病变硅油填充眼并发性白内障的超声乳化IOL植入术联合硅油取出手术效果满意,可减少患者多次手术的痛苦。     

重硅油填充治疗增生性糖尿病视网膜病变的临床研究

目的 观察重硅油作为眼内填充剂治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的有效性和安全性.方法 采用标准玻璃体切割联合重硅油Oxane HD填充术治疗PDR患者29例(29眼),观察重硅油填充期术眼的最佳矫正视力、视网膜复位情况、术后并发症等.结果 重硅油填充期平均为109 d,19例患者最佳矫正视力较术前提高,其余患者视力无提高,无术后视力下降患者.1例患者出现重硅油填充后视网膜脱离,其余患者视网膜均平伏,2例患者术后玻璃体再出血.术后主要并发症包括高眼压、葡萄膜炎、晶状体混浊、硅油乳化、黄斑前膜形成等.结论 重硅油Oxane HD作为眼内填充物可以有效安全地治疗PDR.     

玻璃体切割术治疗增生性糖尿病视网膜病变

目的观察玻璃体切割术治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床疗效。方法回顾性分析行玻璃体切割术治疗的71例(76眼)PDR患者临床资料,观察术后视力及并发症情况,并对PDR不同分期患者的术后视力进行对比,总结影响术后视力恢复的因素。结果术前视力:光感3眼,手动24眼,数指13眼,0.02～0.1者20眼,≥0.1者16眼;术后视力:光感1眼,手动6眼,数指16眼,0.02～0.1者10眼,≥0.1者43眼;手术前后视力差异有显著统计学意义(P=0.000)。其中Ⅳ期、Ⅴ期、Ⅵ期患者中分别有20眼、18眼、16眼术后视力不同程度提高,手术前后视力差异均有统计学意义(P=0.001、0.025、0.036)。术后并发症有角膜水肿伴硅油继发性青光眼,前房纤维素性渗出,玻璃体再次积血,黄斑区及周围视网膜点状出血、渗出等。结论玻璃体切割术疗效明显,可改善大多数患者视功能,是治疗PDR的安全、有效方法。     

Vitrectomy results in proliferative diabetic retinopathy

To evaluate the effectiveness of vitrectomy on eyes with proliferative diabetic retinopathy (PDR). · METHODS: A total of 139 eyes of 93 cases with PDR underwent vitrectomy and were followed up for 3-24 months (16.72±8.53 months; mean±SD). The visual acuity and the factors causing recurrence of operation were analyzed. · RESULTS: The visual acuity was improved in 98 eyes (70.50%) after vitrectomy. The mean postoperative visual acuity was significantly better than the mean preoperative visual acuity. The main reasons for the failure of operation were retinal detachment and maculopathy. · CONCLUSION: These results demonstrate that vitrectomy is generally an effective procedure in treating PDR     

玻璃体切除治疗增生性糖尿病视网膜病变

目的:观察玻璃体视网膜手术治疗增生性糖尿病视网膜病变的临床效果。方法:回顾性分析55例65眼经过玻璃体切除、剥膜、眼内光凝、硅油或C3F8填充术的晚期增生性糖尿病视网膜病变的临床资料,术后随访6mo~1a,观察视力、眼压、视网膜情况以及手术并发症。结果:患者65眼均顺利完成玻璃体手术,32眼眼内填充硅油,8眼填充C3F8,25眼平衡盐液填充。术后视力手动者2眼,数指~0.05者18眼,>0.05~0.1者28眼,>0.1~0.3者12眼,>0.3者5眼,42眼视力提高。7眼视网膜裂孔,8眼有局限性纤维增生膜残留,5眼视网膜脱离,18眼眼压升高,12眼再发玻璃体出血,36眼术后补充光凝治疗1~3次。结论:玻璃体切除术联合眼内激光治疗增生性糖尿病视网膜病变患者是一种有效的治疗手段,硅油填充对于眼内出血有限制作用。     

Vitrectomy for proliferative diabetic retinopathy

PURPOSE: We reviewed the outcome of vitrectomy for proliferative diabetic retinopathy (DR) and evaluated factors affecting the final visual outcome. METHODS: We performed primary vitreous surgery for proliferative DR in 148 eyes of 118 cases in three years from July 1999 to August 2002. All cases were followed for at least 3 months. We excluded vitreous surgery for diabetic maculopathy. Ages ranged from 24 to 80 (mean 57) years. Average postoperative follow-up period was 15 months. We evaluated the stage of DR by the new Fukuda classification. RESULT: Preoperative classification consisted of BIV (54 eyes, 36%), BV (94 eyes, 64%), and BV + VI (36 eyes). Final visual acuity was improved by 2 lines or more in 102 eyes (69%), remained unchanged in 28 eyes (19%), and decreased by two lines or more in 18 eyes (12%). There was a statistical correlation between preoperative visual acuity and final visual acuity. Earlier stages of DR had better visual outcome. Compared to the surgical outcome in the 1990s, the percentage of worsened eyes decreased. CONCLUSION: Vitrectomy for proliferative DR may be beneficial if performed in the earlier stages of DR or if the patient has better visual acuity before vitrectomy.     

Vitrectomy in florid proliferative diabetic retinopathy

In 11 eyes out of 7 patients, vitrectomy was performed for progressive proliferative diabetic retinopathy. The indication for vitrectomy was as follows: (1) macular traction with fibrovascular proliferation on the disk; (2) progressive proliferation with vitreous hemorrhage; (3) fibrovascular proliferation on the disk in spite of intensified scattered photocoagulation. 3 eyes were operated a second time, 1 needed a third vitrectomy after nonresolving hemorrhage. Visual acuity increased after vitrectomy in 9 eyes. In 4 eyes new proliferations on the disk occurred. After an observation period of 1 year, 7 eyes show a stable course.     

玻璃体切除治疗增殖性糖尿病视网膜病变

目的:评价玻璃体切除术治疗增殖性糖尿病视网膜病变的效果。方法:93例(139眼)增殖性糖尿病视网膜病变病例均行玻璃体切除术,术后平均随访(16.72±8.53)mo,对视力及手术失败的原因进行回顾性分析。结果:98眼(70.50%)视力得到提高,术后视力明显好于术前(P<0.001);手术失败的主要原因是视网膜脱离和黄斑病变。结论:玻璃体切除术是治疗增殖性糖尿病视网膜病变的有效方法。     

玻璃体手术治疗增殖性糖尿病视网膜病变

目的评价玻璃体手术治疗增殖性糖尿病视网膜病变的疗效.方法回顾分析玻璃体手术治疗PDR患者65例80眼的临床资料.随访62眼,随访期3～26个月(平均8.3个月).按Ryan and All标准比较Ⅰ组(玻璃体积血或伴有纤维血管增殖)32眼和Ⅱ组(除玻璃体积血或伴有纤维血管增殖外,合并视网膜脱离)30眼的疗效.结果功能成功工组27眼,Ⅱ组13眼;解剖成功Ⅰ组3眼,Ⅱ组8眼;失败Ⅰ组2眼,Ⅱ组9眼.两组间差异有极显著性(P＜0.001).结论玻璃体手术治疗PDR,仅有玻璃体积血或伴有纤维血管增殖组疗效优于合并有视网膜脱离组,术前光定位不良患眼预后差,手术宜慎重考虑.     

Temporary silicone oil implantation following vitrectomy in proliferative diabetic retinopathy

Report on 23 patients with proliferative diabetic retinopathy who underwent silicone oil implantation due to recurrent intravitreal hemorrhages following pars plana vitrectomy. Postoperatively, it was possible to perform panretinal laser photocoagulation without difficulty or haste. After an average period of 4 months, silicone oil was removed from 10 eyes. Subsequent hemorrhages in 4 of these eyes are due to diabetic retinopathy, not to silicone oil. In 6 cases, silicone oil removal is planned for the near future; in a further 7 cases, silicone oil removal has been postponed because of the potential danger of further traction retinal detachment.     

玻璃体切除术联合晶状体手术治疗增生性糖尿病性视网膜病变

目的:评价玻璃体手术联合晶状体手术治疗增生性糖尿病性视网膜病变的临床效果。方法:对68例68眼增生性糖尿病性视网膜病变合并白内障患者行玻璃体切除术联合晶状体超声乳化吸出术治疗,其中35例Ⅰ期植入折叠型后房型人工晶状体。结果:术后43例(63.2%)患者视力提高,术中无严重并发症发生,术后7例(10.3%)角膜上皮愈合延迟,5例(7.4%)发生新生血管性青光眼,6例(8.8%)发生复发性玻璃体积血,4例(5.9%)发生复发性视网膜脱离,4例(5.9%)发生后发性白内障。结论:玻璃体切除术联合晶状体超声乳化吸出术治疗增生性糖尿病性视网膜病变合并白内障,可以改善视功能。     

玻璃体切割联合白内障手术治疗增生性糖尿病视网膜病变

目的观察玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术及硅油填充术治疗增生性糖尿病视网膜病变的疗效。方法将63例(67眼)增生性糖尿病视网膜病变患者进行玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等,术后随访3～18个月观察治疗效果。结果单纯玻璃体视网膜手术23眼,联合晶状体超声乳化人工晶状体植入术25眼,术中注入硅油37眼。术后矫正视力不同程度改善52眼,11眼不变,4眼下降。术中眼内出血5眼;术后玻璃体积血2眼,视网膜上出血2眼,一过性高眼压14眼,继发性青光眼2眼,白内障加重或形成13眼,后发性白内障形成6眼。结论玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等治疗增生性糖尿病视网膜病变安全有效,联合手术可避免再次行白内障手术,减少视网膜脱离、白内障、继发性青光眼等并发症的发生率。     

增生型糖尿病视网膜病变黄斑裂孔的手术治疗

目的 评价玻璃体切割术治疗增生型糖尿病视网膜病变黄斑裂孔疗效。并分析有关因素。方法 12例增生型糖尿病视网膜病变黄斑裂孔患者接受玻璃体切割术治疗，硅油填充3眼，18?F8填充9眼，平均随访6个月（3-24个月）。结果 黄斑裂孔闭合率83%（10/12），视网膜复位率83%（10/12），术后视力提高10眼（83%，10/12），不变2眼（17%，2/12）。并发症主要包括术后短暂高眼压2眼，晶状体核硬化3眼。视网膜脱离复发2眼。结论 玻璃体切割术是治疗增生型糖尿病视网膜病变黄斑裂孔安全有效的方法。     

Phacoemulsification and foldable intraocular lens implantation combined with vitrectomy and silicone oil tamponade for severe proliferative diabetic retinopathy

PURPOSE: To determine the clinical outcomes of phacoemulsification and foldable intraocular lens (IOL) implantation combined with primary vitrectomy and silicone oil tamponade to treat severe proliferative diabetic retinopathy (PDR). SETTING: Department of Ophthalmology, Seoul National University College of Medicine, and Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea. METHODS: The results of combined cataract surgery and silicone oil injection in 20 eyes (20 patients) were retrospectively analyzed. All patients had tractional or tractional-rhegmatogenous retinal detachment and clinically significant lens opacities; none had previous intraocular surgery. An acrylic foldable IOL was implanted in the capsular bag or ciliary sulcus. RESULTS: Primary anatomic success was achieved in 90% of eyes. Functional success was attained in 60% of eyes after a mean follow-up of 7.6 months. The postoperative visual acuity improved in 60% of patients, was unchanged in 20%, and was worse in 20%. Silicone oil was removed in 80% of patients without complications after a mean of 3.4 months. The mean absolute value of the difference between the predicted refraction and postoperative refraction was 0.74 diopter (D) (range 0.03 to 1.74 D). CONCLUSION: Phacoemulsification and foldable IOL implantation combined with primary vitrectomy and silicone oil tamponade was performed safely with favorable anatomic and visual outcomes in eyes with severe PDR.