玻璃体切割联合超声乳化人工晶状体植入治疗糖尿病视网膜病变观察

目的 探讨玻璃体切割联合I期超声乳化人工晶状体植入术治疗增殖性糖尿病性视网膜病变的临床疗效及并发症.方法 分析90只眼增殖性糖尿病性视网膜病变,进行白内障超声乳化联合常规三通道玻璃体切割及眼内光凝,囊袋内植入后房型人工晶状体手术的疗效及并发症.依术中玻璃体腔内填充物不同分为三组,注灌注液为I组28只眼,注惰性气体14%C_3F_8为Ⅱ组49只眼,注硅油为Ⅲ组13只眼.结果 术后随访三个月内,术后视力提高81只眼(90%),不变者7只眼(7.8%),下降者2只眼(2.2%).其中矫正视力0.5以上者23只眼(25.6%),0.1～0.4者44只眼(48.9%),最佳矫正视力为1.0.-过性高眼压24只眼(26.7%),其中I组2只眼,Ⅱ组16只眼,Ⅲ组6只眼.合并葡萄膜炎虹膜粘连者术后前房炎症反应重,视力恢复差.无一例人工晶状体移位发生.结论 玻璃体切割联合I期超声乳化人工晶状体植入术治疗增殖性糖尿病性视网膜病变是安全、有效的,但需要熟练的手术技巧为前提.     

不同术式治疗增殖性糖尿病视网膜病变的疗效分析

目的评价玻璃体切除联合超声乳化人工晶状体植入术(联合手术)和单纯玻璃体切除术治疗增殖性糖尿病视网膜病变的临床效果。方法回顾性分析了33例(41眼)行联合手术与36例(42眼)行单纯玻璃体切除治疗的增殖性糖尿病视网膜患者,手术前后的眼部病情、视力及手术并发症等临床资料。平均随访时间分别为20月和21月。结果2组患者手术后视力较均术前提高,但2组之间差异无统计学意义;联合手术组术前虹膜新生血管在术后1～2月内完全消退(5眼),单纯玻璃体切除组只有1眼完全消退(P<0.05);联合手术组有9眼术后前房内纤维素渗出膜形成,单纯玻璃体切除组只有1眼,差异有统计学意义(P<0.05);联合手术组有7眼术后形成虹膜后粘连,单纯玻璃体切除组只有1眼(P<0.05);联合手术组有4眼术后再行玻璃体切除术,占9.8%,单纯玻璃体切除有8眼占19%(P>0.05)。结论联合手术治疗增殖性糖尿病视网膜病变是安全有效的,早期恢复患者的视力,避免再次手术,但联合手术后前房炎性反应、虹膜后粘连的发生率较高。     

联合手术治疗增生性糖尿病视网膜病变的研究

目的 评价玻璃体切除联合晶状体切除或超声乳化吸出人工晶状体植入术(联合手术)和单纯玻璃体切除术治疗伴有轻度白内障的增生性糖尿病视网膜病变的临床效果.方法 回顾性分析了32例(40眼)联合手术与28例(33眼)单纯玻璃体切除术治疗的增生性糖尿病视网膜病变的临床资料,包括手术前后的眼部状况、视力及手术并发症等.结果 两组手术后视力较术前提高者,联合手术组占77.50％,单纯玻切组占66.67％,两组之间差异有统计学意义(x2=4.74,P＜0.05).联合手术组术前5眼虹膜新生血管在术后1～2个月内5眼均完全消退,单纯玻璃体切除组7眼中仅有1眼完全消退.联合手术组有9眼术后前房内纤维素渗出膜形成,单纯玻璃体切除组只有1眼.联合手术组有7眼术后形成虹膜后粘连,单纯玻璃体切除组只有1眼.结论 联合手术治疗增生性糖尿病视网膜病变是安全有效的,可较早恢复视力,避免再次行白内障手术,但联合手术后前房炎性反应、虹膜后粘连的发生率较高.     

玻璃体切除联合白内障超声乳化吸除人工晶状体植入术后并发症分析

目的 探讨玻璃体切除术联合向内障超声乳化吸除和人工晶状体植入术的有效性和安全性.方法 回顾性分析2000年1月至2007年12月施行联合手术的玻璃体视网膜病变患者81例(82只眼).其中男33例(33只眼),女48例(49只眼),年龄26-78岁,平均57岁;术后随访8～58个月,平均26个月.对术后并发症进行了分析.结果 术后视力提高有55只眼(67.07%);视力不变25只眼(30.49%),视力下降2只眼(2.44%).术后主要并发症包括角膜轻度水肿10只眼(12.20%);暂时性眼压升高26只眼(31.70%);前房渗出12只眼(14.63%);虹膜后粘连6只眼(7.32%);玻璃体再出血5只服(6.10%);视网膜脱离3只眼(3.66%);新生血管性青光眼6只眼(7.32%);术后6个月至2年后囊膜混浊12只眼(14.63%).结论 联合手术及折叠式人工晶体植入治疗伴有白内障的玻璃体视网膜病变是安全有效的方法,术后较快地恢复视力,术后并发症大多数轻微,但糖尿病玻璃体视网膜病变术后并发症相对较多.     

超声乳化、囊袋内人工晶状体植入联合玻璃体切割术治疗增殖性糖尿病视网膜病变

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割术治疗增殖性糖尿病视网膜病变的临床效果。方法:回顾性分析了33例(41眼)行晶状体超声乳化、后房型人工晶状体植入、玻璃体切割联合手术治疗增殖性糖尿病视网膜病变患者的病程、视力及手术并发症等临床资料。结果:41眼均为囊袋内植入人工晶状体,后囊膜完整。41眼中36眼(88%)视力提高,视力>0.05者占73%(30/41),>0.2者占46%(19/41),平均随访时间9mo。31眼术前未接受过眼内激光治疗,术中行全视网膜光凝。5眼术后玻璃体再次出血,1眼术后视网膜脱离复发,其中4眼再次行玻璃体视网膜手术。结论:晶状体超声乳化、囊袋内人工晶状体植入联合玻璃体切割术治疗增殖性糖尿病视网膜病变是安全有效的,有利于保持血—房水屏障,减少术后虹膜红变,早期恢复患者视力,避免再次白内障手术或二期人工晶状体植入。     

玻璃体切除联合白内障手术治疗55例PDR疗效分析

目的:评价玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗增生性糖尿病视网膜病变(PDR)的疗效及并发症。方法:回顾性分析55例68眼伴有白内障的PDR患者行玻璃体切除联合晶状体超声乳化及人工晶状体植入术的临床资料,观察术后视力改善程度及术中、术后并发症。结果:术后随访3～24(平均8.5)mo。51眼(75%)术后视力维持或改善,17眼(25%)视力下降,其中无光感6眼(9%);术中并发症为医源性视网膜裂孔15眼(22%);术后并发症:前房炎性反应30眼(44%),玻璃体积血11眼(16%),复发性视网膜脱离3眼(4%),虹膜红变5眼(7%),新生血管性青光眼2眼(3%);31眼(46%)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状体植入术治疗PDR,可使大多数患者的视力改善,手术是安全的,手术成功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。     

增生性糖尿病性视网膜病变的手术治疗--玻璃体切除联合晶状体超声乳化吸出术

目的　评价玻璃体手术联合晶状体乳化吸出术治疗增生性糖尿病性视网膜病变的临床效果。方法　回顾性分析3 8例 (4 1眼 )行玻璃体切除联合晶状体乳化吸出术的伴有白内障的增生性糖尿病性视网膜病变的临床资料 ,其中 3 7眼同期植入后房型人工晶状体。结果　术后随访 3～ 5 5月 ,平均 (12± 10 6)月。 2 7眼 (65 9% )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 3眼 (7 3 % ) ,玻璃体积血 5眼 (12 2 % ) ,复发性视网膜脱离 3眼 (7 3 % ) ,新生血管性青光眼 4眼(9 8% )。 14眼术后需要进一步治疗 ,包括眼内光凝、玻璃体手术和青光眼滤过手术。结论　玻璃体切除联合晶状体乳化吸出术治疗增生性糖尿病性视网膜病变 ,可使大多数患者的视力改善 ,手术是安全的     

晶状体超声乳化联合玻璃体手术治疗合并白内障的增生性糖尿病视网膜病变

目的分析晶状体超声乳化联合玻璃体手术治疗合并白内障的增生性糖尿病视网膜病变(PDR)的疗效。设计回顾性临床病例系列。研究对象123只合并不同程度白内障的PDR患眼。方法对123只合并不同程度白内障的PDR患眼实施晶状体超声乳化联合玻璃体手术治疗,同时I期植入人工晶状体(IOL),观察术后视力改善程度及术中术后并发症。主要指标术后视力改善程度、术后并发症发生率。结果123眼均实施晶状体超声乳化联合玻璃体手术,并同时一期植入IOL于囊袋内。随访时间3￣21月(平均10个月)。99眼(81%)术后均有不同程度的视力改善。其中93眼(76%)术后视力提高2行或以上。术后无明显角膜水肿和角膜内皮失代偿发生。1例I型糖尿病患者术后6个月发生新生血管性青光眼;1眼术后发生视网膜脱离,再次手术后复位;4眼因玻璃体腔出血再次手术。术后视力无明显改善或视力提高不足2行的病例均合并不同程度的糖尿病黄斑病变。结论晶状体超声乳化联合玻璃体手术是提高合并白内障的PDR患者视力的有效手段。糖尿病黄斑病变是影响术后视力提高的主要因素。(眼科,2006,15:198-201)     

玻璃体切除治疗增生性糖尿病视网膜病变保留晶状体前囊膜的临床观察

目的 探讨保留晶状体前囊膜技术在增生性糖尿病视网膜病变(PDR)手术治疗中的临床效果.方法 系列病例研究.对伴有晶状体混浊和累及眼底后极部的牵拉性视网膜脱离或牵拉-孔源性视网膜脱离的51例(58只眼)PDR患者,在行玻璃体切除手术中,采用经睫状体平坦部切除或超声粉碎吸出晶状体核及皮质并保留前囊膜的技术,处理混浊的晶状体,完成玻璃体手术后给予硅油充填.术后对晶状体前囊膜照相,并对其透明度进行分级评价,对与手术相关的并发症及其处理方法、患者视力和眼压、视网膜复位情况进行分析.结果 玻璃体切除硅油充填并保留晶状体前囊膜的58只眼中,晶状体前囊膜透明度:A级26只眼(44.8%),B级20只眼(34.5%),C级7只眼(12.1%);D级5只眼(8.6%).46只眼(79.3%)术后最佳矫正视力≥0.05,21只眼接受二期人工晶状体植入术.最终7只眼因视网膜不能复位,黄斑裂孔未闭合,而未行硅油取出术.手术并发症:误切虹膜1只眼,硅油进入前房7只眼,虹膜新生血管形成及新生血管性青光眼各1只眼,术后高眼压4只眼,继发性黄斑和视网膜前膜11只眼,黄斑裂孔2只眼.结论 保留晶状体前囊膜,酌情行二期人工晶状体植入术,是处理严重PVR眼的一种较好方法.晶状体上皮细胞残留和积血的长期存在是晶状体前囊膜混浊的主要原因,硅油进入前房是玻璃体切除术中应用保留晶状体前囊膜技术的主要并发症之一.     

晶状体玻璃体视网膜联合手术的临床观察

目的　探讨晶状体玻璃体视网膜联合手术的可行性和疗效。方法　对 2 3例 (2 5只眼 )晶状体玻璃体视网膜联合手术进行了回顾分析。结果　术后 2 1只眼 (84 % )视网膜平伏 ,2 0只眼 (80 % )视力有不同程度的提高 ,术后主要的并发症是炎症反应和晶状体后囊膜混浊。结论　晶状体玻璃体视网膜联合手术是治疗复杂性视网膜脱离的主要方法之一 ,术后视力主要取决于术前视网膜病变和术后并发症等情况     

Vitrectomy for proliferative diabetic retinopathy associated with iris rubeosis]

OBJECT: To compare the results of vitrectomy for phakic cases and those of aphakic cases with proliferative diabetic retinopathy (PDR) accompanied by rubeosis iridis. MATERIALS & METHODS: We reviewed 34 eyes of 24 cases that underwent vitrectomy for proliferative diabetic retinopathy with rubeosis iridis. RESULT: Phakic eyes needed significantly more reoperations (p < 0.001) than aphakic eyes. Aphakic eyes had significantly more successful visual results (p < 0.05) and better control of intraocular pressure (p < 0.005) than phakic eyes. CONCLUSION: This study showed the possibility that phakic eyes had more ischemic retina producing more angiogenic factors than aphakic eyes which had the same grade of rubeosis iridis. Phakic eyes with pre-operative rubeosis iridis need thorough clearance of ocular ischemia by panretinal photocoagulation.     

晶状体摘除对糖尿病视网膜病变玻璃体视网膜手术效果的影响

目的 探讨晶状体摘除对糖尿病视网膜病变(diabetic retinopathy,DR)玻璃体视网膜手术(vitreoretinal surgery,VRS)效果的影响.方法 回顾性分析2001年2月至2007年8月行VRS的68例(80只眼),比较摘除晶状体眼同人工晶状体眼与保留晶状体眼的手术效果,随访5～63个月,平均(12.24±9.13)月.结果 术后87.27%的保留晶状体眼及68%的摘除晶状体眼视力提高或不变(x2=4.191,P=0.062);再次VRS率在保留晶状体组为12.7%,摘除晶状体组20%(x2=0.713.P=0.502);解剖复位率在保留和摘除晶状体眼分别为92.73%和96%(x2=0.314,P=1.000);保留晶状体组和摘除晶状体组各2只眼发生虹膜红变(x2=689,P=0.585),差异均无统计学意义.术后摘除晶状体组前房纤维素性渗出和黄斑水肿的发生率较保留晶状体组增加,差异有统计学意义(P<0.05).结论 晶状体摘除并不增加DR再次VRS率和虹膜红变的发生率,但术后前房纤维素性渗出和黄斑水肿的发生率增加.     

Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications

One hundred seventy-nine eyes were analyzed to determine the incidence of postoperative complications after vitrectomy for proliferative diabetic retinopathy. One hundred twenty-nine (72%) of the 179 eyes achieved improved vision, and 117 (65%) were considered visual successes with final vision in the functional range of 5/200 or better. Corneal epithelial defects occurred in 51 eyes (28%), but severe corneal complications were rare, and no eye developed corneal clouding as the sole cause of later visual loss. The lens was retained in 128 eyes (75%), and visually significant lens opacities occurred later in 17% of the phakic eyes. Postoperative iris neovascularization was reduced by not removing the lens, and rubeosis iridis occurred in 15 (13%) of 114 phakic eyes and in 21 (32%) of 65 aphakic eyes (P = 0.012). Vitreous hemorrhage was present in 75% of eyes immediately after surgery and cleared in an average of 6.2 weeks in phakic eyes and 5.4 weeks in aphakic eyes. Fifty-two eyes (29%) had recurrent vitreous hemorrhage after the initial postoperative period. New retinal detachment occurred after surgery in 16% of eyes and was treated successfully in 38%. Reoperations were done in 45 eyes (25%), and 32 (71%) of these were for repair of retinal detachment or removal of nonclearing vitreous hemorrhage. Six eyes (3%) developed phthisis bulbi, and one other eye was enucleated.     

Posterior chamber intraocular lens implantation during diabetic pars plana vitrectomy

Combined cataract removal, posterior chamber intraocular lens (PC IOL) implantation, and pars plana vitrectomy were performed in 15 diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy (PDR). Posterior chamber IOLs were placed anterior to the anterior lens capsule after pars plana lensectomy and vitrectomy in nine eyes, whereas extracapsular cataract extraction (ECCE) with PC IOL placement was performed before vitrectomy in six eyes. Panretinal laser endophotocoagulation was applied in 13 of the 15 eyes as an important part of the operative procedure. Because of inactive diabetic retinopathy or satisfactory preoperative panretinal photocoagulation, 2 of the 15 eyes did not receive laser endophotocoagulation. Visual acuity was improved in 12 eyes and was similar to preoperative vision in 3 eyes. After a minimum of 6 months and a maximum of 28 months of follow-up, the visual results are the following: 20/40 or better (4 eyes), 20/50 to 20/200 (5 eyes), 20/400 to 5/200 (5 eyes), and hand motions (1 eye). Although 5 of the 15 eyes required secondary vitreoretinal procedures, neovascular glaucoma and complications attributable to the IOL did not occur. A recurrent postoperative retinal detachment (RD) developed with subsequent hypotony and rubeosis iridis in 1 of the 15 eyes.     

增殖型糖尿病视网膜病变玻璃体切割手术后的视力及影响因素

作者分析增殖型糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)合并严重玻璃体出血、黄斑部视网膜前出血、牵拉性视网膜脱离、牵拉性视网膜脱离并发孔源性视网膜脱离共81只眼进行玻璃体切割手术的结果。83.9%的患眼手术后视力获得不同程度的改善，PDR的严重程度对手术后视力有一定的影响，V期患者手术后出血率较高。虹膜红变的发生率与PDR的严重程度无关，但晶体切割眼的虹膜红变发生率高于有晶体眼。手术后视网膜脱离和出血不吸收均可导致虹膜红变的发生。 （中华眼底病杂志，1995，11：216-218）     

Vitrectomy and subsequent photocoagulation in proliferative diabetic retinopathy with vitreous hemorrhage

Forty eyes in 39 patients with proliferative diabetic retinopathy, vitreal hemorrhage and progressive neovascularization in at least 3 fundus quadrants were treated with panretinal xenon photocoagulation immediately after pars plana vitrectomy. Lens extraction was performed on 7 eyes and 2 eyes were aphakic. Six months after treatment, 68% of the eyes showed an improvement in vision, 25% had vitreal rebleeding and 11% developed rubeosis iridis. While treatment had no effect on peripheral rubeosis iridis in 5 eyes, all 7 eyes with pupillary rubeosis iridis showed complete regression. The results indicate the clinical value of combining, pars plana vitrectomy with panretinal xenon photocoagulation in selected patients.     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.