探讨糖尿病视网膜病变玻璃体出血的手术时机

分析2005年3月～2009年2月被我院确诊为DR所致玻璃体出血并行玻璃体切割术治疗的患者616例,785眼。依据玻璃体出血距手术治疗的时间分为1月组、2月组、3月组、大于3月组,手术采用标准20G玻璃体切割术,术后随访9月～36月,观察术后最佳矫正视力和手术并发症发生情况。结果:术后最佳矫正视力及并发症发生的眼数:1月组0.5±0.22、7只眼,2月组0.5±0.13、21只眼,3月组0.37±0.18、62只眼,大于3月组0.29±0.16、117只眼。结论:DR引起的玻璃体出血,术后最佳矫正视力随出血距手术时间的延长而呈现下降趋势,手术并发症呈上升趋势。     

玻璃体切除治疗糖尿病视网膜病变

玻璃体切除治疗糖尿病视网膜病变济南市第二人民医院（２００００１）王玉，卢信义糖尿病患者失明的主要原因是增殖性糖尿病性视网膜病变（ＰＤＲ）合并严重玻璃体出血、牵引性视网膜脱离和新生血管性青光眼等并发症。据Ｅｔｄｒｓ，报道。尽管对此进行了全视网膜光凝治疗...     

糖尿病视网膜病变玻璃体切除术后新生血管性青光眼发生的原因分析

目的分析采用玻璃体切除术治疗糖尿病视网膜病变后发生新生血管性青光眼(NVG)的具体原因。方法选取2014年1月-2019年1月期间由该院收治的224例(232眼)糖尿病视网膜病变患者作为研究对象,对224例患者病例进行回顾性分析。将224例患者分为两组:NVG组和非NVG组,分析糖尿病视网膜病变患者经过玻璃体切除术后发生NVG的主要因素。结果非NVG组为206例214眼;NVG组为18例18眼,联合白内障手术10眼,晶状体后囊膜缺失或不完整5眼,合并高血压12眼,合并高血脂13眼,再行玻璃体切除术5眼,已行硅油移除眼或硅油填充眼2眼。比较两组患者:合并高血压、再行玻璃体切除术、及联合白内障手术情况,差异无统计学意义(χ^2高血压=0.440,P=0.506>0.05),Fisher确切概率法(P再次行PPV术=0.077);差异无统计学意义(χ^2白内障=0.192,P=0.660>0.05)。结论选择正确时机进行玻璃体手术,并恰当选取玻璃体腔填充物,可以有效降低糖尿病视网膜病变患者在玻璃体切除术后发生NVG的几率。     

阿柏西普联合玻璃体切除术治疗增殖型糖尿病视网膜病变临床观察

目的 观察玻璃体腔注射阿柏西普联合玻璃体切除术对增殖型糖尿病视网膜病变(PDR)的治疗效果.方法 选取59例PDR患者并将其随机分为对照组29例、观察组30例.两组行常规玻璃体切除术;另外观察组于术前3～5 d行玻璃体腔内注射阿柏西普0.05 mL,按压注射部位30～60 s.用ELISA实验检测玻璃体腔内血管内皮生长...     

玻璃体切除术治疗增殖性糖尿病视网膜病变的疗效分析

目的探讨玻璃体切除术治疗增殖性糖尿病视网膜病变的临床疗效。方法随机选取2012年1月—2014年1月在该院诊治的134例(176眼)增殖性糖尿病视网膜病变患者,随机平均分为对照组和研究组,每组67例(88眼),给予对照组采取全视网膜光凝治疗,给予研究组应用玻璃体切除术进行治疗,记录并分析两组相关情况。结果治疗后,研究组患者Ⅳ期、Ⅵ期视力好转情况优于对照组,视力无变化和恶化眼数都较对照组更少;Ⅴ期视力好转情况明显较对照组更好,视力恶化眼数比对照组更少;研究组患者继发性青光眼并发症发生率明显低于对照组,组间比较差异均具有统计学意义(P<0.05)。结论增殖性糖尿病视网膜病变应用玻璃体切除术治疗具有良好临床疗效,值得临床推广。     

四切口玻璃体手术治疗增殖性糖尿病视网膜病变的疗效观察

目的 探讨经睫状体平坦部四切口玻璃体手术治疗增殖性糖尿病视网膜病变(PDR)的疗效.方法 对18例(22眼)行经睫状体平坦部四切口玻璃体手术的PDR患者进行回顾性分析,随访6～18个月.结果 术后视力改善17眼(77.27%);3眼视力不变(13.64%);2眼视力下降(9.09%).结论 四切口玻璃体手术使术者得以采用双手操作行眼内的膜分离、膜剥除,可明显缩短手术时间,提高手术效率,减少组织损伤,是治疗PDR的较好方法.     

红细胞膜脂肪酸成分,膜流动性改变分糖尿病视网膜病变的关系

目的 探讨红细胞膜脂肪酸成分和膜流动性与糖尿病视网膜病变（ＤＲ）之间的关系。方法 采用高效液相色谱法和荧光偏振技术测定２９例正常人和６３例非胰素依赖型糖尿病９ＮＩＤＤＭ）患者红细胞膜脂肪酸成分和膜微粘度。结果 ＮＩＤＤＭ病人红细胞膜花生四烯酸含量及百分组成明显低于正常对照组。而膜微粘度则同于对照组，且在伴有ＤＲ人膜微粘度又明显高于不伴有ＤＲ组。患者膜微粘度与膜软脂酸和硬脂酸百分组成呈明显正相关，而     

玻璃体切割联合硅油填充术治疗晚期增殖性糖尿病视网膜病变疗效观察

目的评价玻璃体切割联合硅油填充治疗晚期增殖性糖尿病视网膜病变（PDR）的疗效。方法对29例33眼行玻璃体切割联合硅油填充术治疗的Ⅵ期PDR患者从视力预后、视网膜复位、手术并发症的角度进行回顾性分析。结果 33眼随访1.5~28（7.16±4.45）个月,术后最佳矫正视力较术前提高者占69.69%（23/33）,其中视力在0.1以上者占27.27%（9/33）,视力无明显变化者占15.15%（5/33）,较术前降低者占12.12%（4/33）。33眼中联合超声乳化晶状体摘除13眼,其中术后最佳矫正视力较术前提高7眼,手术前后视力无明显变化5眼,术后视力较术前降低1眼。1次手术视网膜即复位24眼（72.72%）。首要的术中并发症是医源性视网膜裂孔,术后并发症是眼内出血。结论玻璃体切割联合硅油填充术在一定程度上可提高晚期PDR患者的视力,改善其生活质量。     

红细胞膜脂肪酸成分、膜流动性改变与糖尿病视网膜病变的关系

目的探讨红细胞膜脂肪酸成分和膜流动性与糖尿病视网膜病变（ＤＲ）之间的关系。方法采用高效液相色谱法和荧光偏振技术测定２９例正常人和６３例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者红细胞膜脂肪酸成分和膜微粘度。结果ＮＩＤＤＭ病人红细胞膜花生四烯酸（Ｃ２０∶４ｎ－６）含量及百分组成明显低于正常对照组，而膜微粘度则明显高于对照组，且在伴有ＤＲ组其膜微粘度又明显高于不伴有ＤＲ组。患者膜微粘度与膜软脂酸（Ｃ１６∶０）和硬脂酸（Ｃ１８∶０）百分组成呈明显正相关，而与花生四烯酸和廿二碳六烯酸（Ｃ２２∶６ｎ－３）呈明显负相关。结论ＮＩＤＤＭ病人红细胞膜脂酸组成对其膜流动性降低有重要影响，而后者对ＮＩＤＤＭ微血管病变的发生和发展可能起重要作用。     

糖尿病视网膜病变与糖尿病教育的前瞻性研究

40例DR患者,对其进行系统的糖尿病知识学习,并进行考试,观察两年与40例对照组比较。结果 HbA1c 6.1±1.2优于对照组10.2±2.4;TC、TG及LDL有明显下降,HDL升高。需要手术者7人(17.5%),对照组15人(37.5%),(P0.01)。试验组无一人失明,对照组3人。试验组眼底手术者10人次(25%),对照组仅3人次(7.5%)。结论糖尿病教育能有效地阻止DR的进展。     

Pregnancy after vitrectomy for proliferative diabetic retinopathy

A 26-year-old female with insulin-dependent diabetes of 16 years duration had a vitrectomy for a dense non-resolving vitreous haemorrhage. Two months later she became pregnant. She delivered a healthy baby and despite the known adverse effects of pregnancy on retinopathy no deterioration occurred in visual acuity or in retinal appearance.     

玻璃体手术治疗增生型糖尿病视网膜病变544眼疗效分析

目的观察玻璃体手术治疗增生型糖尿病视网膜病变（PDR）的疗效及并发症。方法对455例（544眼）行玻璃体手术治疗的PDR连续性病例进行回顾性分析,比较使用不同眼内填充物的结果。结果544眼中视力≥0.02者由术前的267眼（49.1%）增加到术后的444眼（81.6%）,其中视力≥0.1者由术前的110眼（20.2%）增加到术后的283眼（52.0%）;总视网膜在位眼数499眼（91.7%）,其中灌注液组高达96.2%;白内障发生率在灌注液组最低,为7.9%（18/227）,硅油组最高,为21.0%（17/81）,气体组为14.8%（16/108）;术后玻璃体出血者气体组16眼（11.6%）,硅油组硅油取出后24眼（20.2%）,灌注液组59眼（20.6%）。结论对于无视网膜裂孔及新生血管并发症危险的PDR患者,玻璃体手术保留灌注液即可获得良好预后;术前存在视网膜脱离的PDRⅥ期并非选择硅油或气体的指征。     

Predictors of postoperative bleeding after vitrectomy for vitreous hemorrhage in patients with diabetic retinopathy

Aims/Introduction

To clarify the association between perioperative variables and postoperative bleeding in pars plana vitrectomy for vitreous hemorrhage in diabetic retinopathy.

Materials and Methods

The present retrospective study enrolled 72 eyes of 64 patients who were admitted to Osaka University Hospital between April 2010 and March 2014, and underwent vitrectomy for vitreous hemorrhage as a result of diabetic retinopathy.

Results

Postoperative bleeding developed in 12 eyes. Using binomial logistic regression analysis, we found that the duration of operation was the only significant variable associated with postoperative bleeding within 12 weeks after vitrectomy. Furthermore, Poisson regression analysis identified fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs, as well as duration of operation, to be significantly associated with the frequency of bleeding within 52 weeks after vitrectomy.

Conclusions

Long duration of operation can be used to predict bleeding within both 12 and 52 weeks after vitrectomy. In addition, fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs might be risk factors for postoperative bleeding up to 1 year after vitrectomy.     

雷珠单抗对糖尿病增殖性视网膜病变患者玻璃体切割术的影响

目的 观察玻璃体腔内注射雷珠单抗对增殖性糖尿病视网膜病变（PDR）患者玻璃体切割术实施及预后的影响. 方法 选择PDR患者40例（45眼）,随机分为：试验组20例（22眼）玻璃体腔内注射雷珠单抗0.5 mg,行玻璃体切割术;对照组20例（23眼）直接行玻璃体切割术.分析两组术中、术后临床指标的差异. 结果 试验组平均手术持续时间、术中电凝止血频率及医源裂孔发生率均低于对照组[时间：（96±12）vs（133±15） min,P＜0.001;止血百分率：3（13.6％）vs9（39.1％）,P=0.038;裂空发生率：1（4.54％） vs 4（17.4％）,P=0.034].试验组术后1个月内前房和玻璃体腔积血率均较对照组降低[前房：1（4.54％）vs2（8.70％）,P=0.025;玻璃体腔：1（4.54％）vs3（13.0％）,P=0.048].两组术后视力均较术前提高,组间比较差异有统计学意义（P=0.020）. 结论 PDR患者在玻璃体切割术前注射雷珠单抗可缩短手术时间,减少术中出血及医源性裂孔的发生,减少术中术后并发症,获得更好的术后视力.     

Long-term outcome after photocoagulation for proliferative diabetic retinopathy

One-hundred and forty patients with 182 treated eyes were followed for up to 10 years after photocoagulation for proliferative diabetic retinopathy. Sixty-eight patients were still alive and under review after 10 years. Mortality was 33% at 10 years and the survivors were younger when treated and had lower systolic and diastolic blood pressures, a lower urea and creatinine and a lower prevalence of proteinuria and ECG evidence of ischaemia at baseline. Sixty-nine percent of all patients and 82% of those followed up for 10 years maintained good vision (6/12 or better) in their better eye at the last follow-up. Visual deterioration occurred mostly in the first 2 years after treatment and risk factors for poor final vision were poor vision at baseline, severity of disc new vessels, and age at presentation. It is concluded that the short-term beneficial effect of photocoagulation is maintained over long periods of follow-up.     

Photocoagulation for proliferative diabetic retinopathy: a randomised controlled clinical trial using the xenon-arc

Summary The final results of a randomised controlled study of xenon-arc photocoagulation for proliferative retinopathy are reported, after all patients have been followed for at least 5 years and some for up to 7 years. One hundred and seven patients with two similarly affected eyes had one treated (chosen by a random procedure), while the other eye remained untreated and served as a control. Of the 107 patients, 77 completed the 5 year follow up, 13 died and 17 stopped attending for various reasons. Of the recorded coexistent medical abnormalities, only renal complications affected survival, none influenced visual outcome. Visual outcome was significantly better in the treated than in the control eyes at each yearly interval (0.001<p<0.05). The greatest difference was seen in those with disc vessels at entry. In this group, control eyes deteriorated by a mean of four lines on the Snellen chart, treated eyes by one line only. Six patients became legally blind in both eyes, four were blind in the treated eye only, but 28 control eyes were blind when treated eyes retained vision (p<0.001). Treated eyes which became blind had less treatment than those that retained vision. Of the 42 treated eyes with peripheral new vessels only at entry, 12 developed disc new vessels. These 12 had fewer burns than the 30 which did not develop disc new vessels. It is concluded that in proliferative retinopathy, treatment by photocoagulation is better than no treatment at all. Adequate treatment is required to maintain vision.     

Recovery of visual field defects following vitrectomy for proliferative diabetic retinopathy: A case report

Rationale:Proliferative diabetic retinopathy (PDR) may lead to severe visual impairment, and visual field (VF) loss in such patients has been reported. Vitrectomy is performed in PDR cases complicated with either vitreous hemorrhage or tractional retinal detachment to restore their visual acuity. However, its effect on VF defects is limited in data. Herein, we report the recovery of VF defects following vitrectomy in a patient with PDR.Patient concerns:A 25-year-old female with bilateral PDR and vitreous hemorrhage received 2 monthly intravitreal injections of aflibercept in both eyes. Six months after her last injection, she presented with fibrovascular membrane formation in both eyes and VF defects of −9.02 dB and −20.05 dB in the right and left eye, respectively.Diagnoses:Proliferative diabetic retinopathy in both eyes.Interventions:The patient underwent vitrectomy for her left eye.Outcomes:Although her visual acuity did not improve as expected, results from the Humphrey visual field analyzer showed notably improvement of her left eye (−9.05 dB) after the surgery.Lessons:Vitrectomy potentially allows recovery of VF defects in patients with PDR.     

增殖型糖尿病视网膜病变与肿瘤坏死因子β基因多态性的相关性研究

目的探讨肿瘤坏死因子β（TNF-β）基因多态性和增殖型糖尿病视网膜病变（PDR）之间的相关性。方法用PCR-RFLP方法检测、比较各组间等位基因频率的分布。结果PDR组TNF-β2的基因频率较单纯型糖尿病视网膜病变组增高，差别有统计学意义（P〈0．05）。结论TNF-β基因多态性可能是PDR的一个遗传易感标记。     

Photoreceptors in diabetic retinopathy

Although photoreceptors account for most of the mass and metabolic activity of the retina, their role in the pathogenesis of diabetic retinopathy has been largely overlooked. Recent studies suggest that photoreceptors might play a critical role in the diabetes‐induced degeneration of retinal capillaries, and thus can no longer be ignored. The present review summarizes diabetes‐induced alterations in photoreceptor structure and function, and provides a rationale for further study of a role of photoreceptors in the pathogenesis of the retinopathy.