Pars plana vitrectomy for complicated retinal detachments

The authors used vitreous surgery to treat 514 cases with retinal detachment. Three hundred sixty-five (71%) of the 514 eyes had retinal detachment associated with proliferative diabetic retinopathy. A successful anatomic result was achieved in 245 (67%) of these 365 cases and 227 (62%) obtained final vision of 5/200 or better. Five factors were associated with a successful visual result in diabetic eyes: (1) preoperative visual acuity of 5/200 or better, (2) retaining the crystalline lens, (3) an attached macula preoperatively, (4) preoperative retinal detachment limited to the posterior pole or less than one quarter the fundus area, and (5) absence of iatrogenic retinal breaks. Of those cases without diabetic retinopathy, a successful anatomic result was achieved in (1) 27 (84%) of 32 eyes with nondiabetic traction detachment, (2) 13 (65%) of 20 giant retinal tears, (3) 21 (50%) of 42 eyes with opaque media complicating retinal detachment, (4) 9 (90%) of 10 eyes with posterior retinal breaks, (5) 29 (42%) of 69 eyes with advanced proliferative vitreoretinopathy (PVR), and (6) 29 (64%) of 45 eyes with retinal detachment complicating prior ocular trauma.     

Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series

Purpose:  Bevacizumab (Avastin) is a monoclonal antibody which targets all isoforms of vascular endothelial growth factor A. Its potent anti-angiogenic effects have been shown to cause regression of neovascularization in proliferative diabetic retinopathy. The aim of this study is to investigate the role of Avastin as an adjunct to vitrectomy in the management of severe diabetic eye disease.
Methods:  Sixteen patients (18 eyes) with severe proliferative diabetic retinopathy were recruited into the study. All eyes underwent a single intravitreal injection of bevacizumab 1.25 mg in 0.05 mL prior to vitrectomy surgery for the management of tractional retinal detachment or vitreous haemorrhage due to severe proliferative diabetic retinopathy.
Results:  At 3 months, seven eyes had visual acuities which were better than baseline, four were unchanged and seven were worse. At 6 months, 14 eyes had visual acuities better than baseline, one was unchanged and three were worse. Seven of the 18 eyes (38.8%) had postoperative rebleeds, six of which required surgical washout.
Conclusion:  Avastin improved the ease of the surgery in these complex eyes and the early results are encouraging. We have found it to be particularly useful in diabetic eyes with traction detachments of short duration in which there is still active neovascularization.     

玻璃体切除术治疗增生型糖尿病视网膜病变的效果观察

目的观察分析玻璃体切除术治疗增生型糖尿病视网膜病变（PDR）的效果。方法对行玻璃体手术治疗的54例（63眼）PDR病例进行回顾性分析,并总结造成术后视力不良的原因。结果术后随访5～24个月,术后矫正视力改善48眼（76．19％）,63眼中视力≥0．01者由术前23眼（36．51％）增加到术后49眼（77．78％）,其中视力≥10．1者由术前3眼（4．76％）增加到术后27眼（42．86％）,8眼（12．70％）与术前比较变化不明显,7眼（11．11％）较术前稍有下降。Ⅳ,Ⅴ期患眼术后视力改善程度（84．78％）明显好于Ⅵ期者（52．94％）。结论玻璃体切除术是治疗PDR的有效方法,合理掌握手术时机、减少术中术后并发症对治疗效果很关键。     

Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study

Introduction

End-stage diabetic eye disease is an important cause of severe visual impairment in the working-age group. With the increasing availability of refined surgical techniques as well as the early diagnosis of disease because of screening, one would predict that the prevalence of this condition is decreasing and the visual outcome is improving.

Aim

To study the prevalence and visual outcome following vitrectomy for complications of diabetic retinopathy.

Materials and methods

This study identified the patients who underwent vitrectomy from January 2007 to December 2009 because of diabetes-related complications in South East London. Data collected included baseline demographics, best-corrected visual acuity, indication for the vitrectomy, complication, outcome, and duration of follow-up.

Results

The prevalence of people requiring vitrectomy who are registered in the diabetes register of this region was 2 per 1000 people with diabetes. Vitrectomy was required in 185 eyes of 158 patients during this period. These included 83 Caucasians, 51 Afro-Caribbeans, 17 South Asians, and 7 from other ethnic groups. There were 58 patients with type I diabetes and 100 with type II, with a mean duration of diabetes of 23 and 16.5 years, respectively. The reason for vitrectomy included tractional retinal detachment (TRD) in 109 eyes, non-clearing vitreous haemorrhage (NCVH) in 68 eyes, and other causes in 8 eyes. In all, 50% of the eyes with TRD and NCVH, and 87% of the eyes with NCVH improved by at least three ETDRS lines at 12 months. Poor predictors of visual success included longer duration of diabetes (OR: 0.69), use of insulin (OR: 0.04), presence of ischaemic heart disease (OR: 0.04), delay in surgery (OR: 0.59), and the failure to attend clinic appointments (OR: 0.58). Preoperative use of intravitreal bevacizumab in eyes with TRD undergoing vitrectomy showed a marginal beneficial effect on co-existent maculopathy (P=0.08) and required less laser intervention post procedure, but did not affect the number of episodes of late-onset vitreous haemorrhage post vitrectomy (P=0.81).

Conclusion

Visual outcome has improved significantly in eyes with complications due to diabetic retinopathy compared with the previously reported Diabetic Vitrectomy Study.     

PPV联合抗VEGF治疗增殖性糖尿病性视网膜病变远期疗效的Meta分析

目的：探究玻璃体切除(PPV)术联合或不联合抗VEGF药物治疗增殖性糖尿病性视网膜病变(PDR)的远期疗效。

方法：计算机检索PUBMED、EMBASE、Cochrane Central Register of Controlled Trials(CENTRAL)、Web of Science等多个数据库,查找自建库至2020-07-02关于比较PPV术前是否行抗VEGF药物治疗PDR预后效果的临床随机对照试验(RCT),根据文献纳入与排除标准筛选文献,并进行数据提取和质量评价,主要评价指标包括术后视网膜脱离发生率、黄斑中心凹厚度和最佳矫正视力(BCVA)。

结果：最终纳入11项(880眼)RCT研究。Meta分析结果显示,术前行抗VEGF治疗的PDR患者PPV术后视网膜脱离发生率明显低于未注射抗VEGF药物患者(RR=0.39, 95%CI 0.22～0.71, P=0.002); 亚裔和非亚裔患者中,单纯PPV与联合抗VEGF治疗患者PPV术后视网膜脱离发生率均具有显著差异(亚裔：RR=0.20, 95%CI 0.05～0.87, P=0.03; 非亚裔：RR=0.46, 95%CI 0.24～0.89, P=0.02)。术前抗VEGF治疗的PDR患者PPV术后3、6mo黄斑中心凹厚度均低于PPV术前未行抗VEGF治疗的患者(MD=-78.49, 95%CI -94.81～-62.17,P<0.00001; MD=-39.62, 95%CI -48.44～-30.80, P<0.00001)。术前抗VEGF治疗的PDR患者PPV术后6mo BCVA优于未行抗VEGF治疗的患者(MD=-0.16,95%CI -0.21～-0.10,P<0.00001)。

结论：PPV术前行抗VEGF治疗可有效降低PDR患者术后视网膜脱离发生率,缓解术后黄斑水肿,降低黄斑中心凹厚度,并改善视力预后。     

23 G玻璃体手术系统治疗增生性糖尿病视网膜病变的回顾分析

目的 探讨23 G玻璃体手术治疗增生性糖尿病视网膜病变（PDR）的特点。设计 回顾性病例系列。研究对象 2010年1月至2011年6月北京同仁医院眼底病科连续收治的100例（105眼）接受玻璃体手术治疗的PDR患者。方法  回顾上述患者的病历资料。对手术方式、手术时间、术后视力以及术后炎性反应和并发症等情况进行分析。主要指标  手术方式、手术时间、器械进出眼内次数、术后视力以及术后炎性反应和并发症。结果  105眼接受23 G玻璃体手术。其中术前单纯玻璃体积血者32眼,平均手术时间（52.0±15.2）分钟,平均器械进出眼内（8.5±2.5）次;需剥离视网膜前增生膜而无明显牵拉性视网膜脱离者23眼,平均手术时间（65.0±12.7）分钟,平均器械进出眼内（12.4±3.4）次;伴有明显视网膜脱离者50眼,平均手术时间（87.0±17.1）分钟,平均器械进出眼内（15.7±4.1）次。硅油填充30眼。所有患者无术中锯齿缘离断,术中使用眼内电凝16眼（15.2%）,无使用眼内剪刀者。术后1~3个月视力均有不同程度改善。结论  23 G玻璃体手术适用于从简单到复杂的各种PDR的治疗,熟练掌握23G玻璃体手术能提高手术效率、减少并发症、改善患者愈后。（眼科,2012,21：97-101）     

Preoperative prognostic factors in vitrectomy for severe proliferative diabetic retinopathy

PurposeTo investigate the preoperative prognostic factors contributing to extremely poor visual outcome in cases of proliferative diabetic retinopathy after a successful vitrectomy and an uneventful postoperative course.MethodsWe enrolled 28 consecutive eyes of 28 patients with poor preoperative visual acuity (VA), who underwent primary diabetic vitrectomy. The postoperative course was uneventful, and retinal attachment was achieved for at least 6 months in all cases. The cases were separated into the study group (postoperative VA < preoperative VA) and control group (postoperative VA ≥ preoperative VA). Preoperative factors including systemic diseases, demographic data, proliferative diabetic retinopathy severity, and neovascularization status were compared between the two groups. Significant risk factors for poor visual results were determined by logistic regression analysis.ResultsThe creatinine level was significantly higher in the study group (4.07 ± 4.15 mg/dL) than in the control group (1.23 ± 0.46 mg/dL; p = 0.003). Chronic macular detachment was noted in 7/10 eyes (70%) in the study group and in 1/18 eyes (5.6%) in the control group (p = 0.001). Broad fibrovascular proliferation extending to the periphery for more than two quadrants was found in 4/10 eyes (40%) in the study group and in none of the eyes in the control group (p = 0.016). Chronic macular detachment and broad fibrovascular proliferation were significantly associated with poor visual outcome in multiple logistic regression analysis.ConclusionPreoperative chronic macular detachment, broad fibrovascular proliferation, and poor renal function may indicate worse visual results after successful diabetic vitrectomy for cases with severe diabetic retinopathy.     

Effect of intravitreal conbercept treatment before vitrectomy in proliferative diabetic retinopathy

AIM: To evaluate the safety and efficacy of intravitreal conbercept (IVC) injections as pretreatment for pars plana vitrectomy (PPV) in severe proliferative diabetic retinopathy (PDR). METHODS: This was a retrospective chart review of all patients who underwent PPV for PDR from January 2014 to October 2016. Patients who underwent IVC injection before PPV were assigned to the IVC group; the others were assigned to the control group. The IVC was performed 3-7d before surgery in the IVC group. All the eyes in the two groups were operated by the same doctor to complete the vitrectomy. Intraoperative complications and the changes in best-corrected visual acuity (BCVA) before and after surgery were compared between the two groups. RESULTS: A total of 68 eyes of 63 patients (22 eyes in the IVC group and 46 eyes in the control group) were examined. The risk of intraoperative bleeding was lower in the IVC group (2/22) than in the control group (25/46, P=0.000). Furthermore, the use of endodiathermy was significantly lower in the IVC group (1/22) than in the control group (12/46, P=0.047). The surgical time in the IVC group (112.64±34.52min) was significantly shorter than in the control group (132.85±40.04min, P<0.05). Compared to the BCVA before surgery, the mean BCVA was significantly improved after surgery for both groups (P<0.05). CONCLUSION: PPV is an effective treatment and can improve vision in patients with PDR. Preoperative intravitreal injection of conbercept could reduce the chances of intraoperative bleeding and the use of endodiathermy and shorten the operative time, which are beneficial in the management of PDR.     

微创玻璃体切割联合全视网膜光凝治疗糖尿病视网膜病变

目的：探讨23G微创玻璃体切割联合术治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的安全性及有效性。

方法：对40例40眼纤维血管膜范围>5PD增生性糖尿病视网膜病变患者随机行20G及23G玻璃体切割联合术治疗,回顾上述患者的病历资料。对术后视力、眼内压、术中及术后并发症等情况进行分析。

结果：23G组手术后1,3,6mo的最佳矫正视力为LogMAR(0.88±0.43)、(0.69±0.23)、(0.45±0.17),20G组手术后1,3,6mo的最佳矫正视力为LogMAR(0.57±0.32),(0.41±0.21),(0.30±0.17),两组比较差异无统计学意义。随访时间为6～23mo。

结论：23G玻璃体切割联合术是治疗复杂增生性糖尿病视网膜病变的安全有效方法。     

玻璃体内注射雷珠单抗联合玻璃体切割术治疗严重增生型糖尿病视网膜病变

目的　观察玻璃体内注射雷珠单抗联合玻璃体切割术治疗严重增生型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉ-ｎｏｐａｔｈｙ,ＰＤＲ）的临床效果。方法　将临床确诊为严重ＰＤＲ的患者５２例７２眼纳入本研究。依据术前是否行玻璃体内注射雷珠单抗将患者分为治疗组和对照组:治疗组３０例４２眼、对照组２２例３０眼。治疗组术前３ｄ玻璃体内注射１０ｇ·Ｌ－１雷珠单抗０．０５ｍＬ（０．５ｍｇ）,然后行玻璃体切割术,对照组直接行玻璃体切割术。术后随访３～１２（６．５±１．３）个月。对比分析两组患者视力、眼压、黄斑中心凹视网膜厚度和术后并发症的发生情况。结果　治疗组、对照组手术后视力分别为０．０９０±０．０６８、０．０６０±０．０２９,均较术前提高,２组治疗前、治疗后视力比较差异均有统计学意义（ｔ＝－５．００５、－３．２３７,均为Ｐ＜０．０５）。两组术后视力比较,差异有统计学意义（ｔ＝２．０３４,Ｐ＜０．０５）。治疗组、对照组术后黄斑中心凹视网膜厚度分别为（３１３．８±２７．３）μｍ、（３２５．６±１４．５）μｍ,差异有统计学意义（ｔ＝－１．５１,Ｐ＜０．０５）。术后２周、１个月、３个月,治疗组玻璃体积血发生率分别为１２％、２％、２％,对照组发生率分别为２７％、２０％、３％;两组术后各时间点发生率比较,术后２周及１个月之间差异均有统计学意义（χ２＝３．４２、３．２１,均为Ｐ＜０．０５）,术后３个月差异无统计学意义（χ２＝１．０２,Ｐ＞０．０５）。结论　玻璃体切割术联合玻璃体内注射雷珠单抗治疗严重ＰＤＲ能提高患者视力,降低术后玻璃体积血发生率和黄斑中心凹视网膜厚度。     

Rapid resolution of severe retinal neovascularisation in proliferative diabetic retinopathy following adjunctive intravitreal bevacizumab (Avastin)

A 23‐year‐old aboriginal woman with severe bilateral proliferative diabetic retinopathy and left rubeotic glaucoma received bilateral pan‐retinal photocoagulation with adjunctive intravitreal bevacizumab. Six days post‐injection, there was almost complete resolution of new vessels.     

岛状除膜手术治疗增生性糖尿病视网膜病变

目的研究增生性糖尿病视网膜病变(PDR)有严重纤维血管膜者进行岛状除膜及传统撕膜两种手术的临床效果。方法增生性糖尿病视网膜病变有严重纤维血管膜增生者518例(548眼)分为两组。第1组采用传统的撕膜技术,226例(241眼);第2组采用岛状除膜技术,295例(307眼)。比较两种膜处理技术的视力预后及术后并发症情况。结果第1组术后视网膜裂孔发生率高于第2组,术后玻璃体再出血第2组好于第1组,硅油填充率第2组低于第1组。结论岛状膜清除技术术中视网膜裂孔发生率低,减少了医源性裂孔的发生率,减少了硅油填充率,最大限度挽救增生性糖尿病视网膜病变患者的视功能。     

保留晶状体前囊膜的玻璃体切除术联合超全视网膜光凝治疗PDR

目的：探讨保留晶状体前囊膜的玻璃体切除术联合术中超全视网膜光凝在增殖型糖尿病视网膜病变(PDR)Ⅵ期合并白内障的临床应用。

方法：回顾性分析2010-01/2013-06于我院收治的PDRⅥ期合并白内障患者38例45眼,术前视力均为光感至0.1,入院后行保留晶状体前囊膜的玻璃体切除术,术中行超全视网膜光凝(E-PRP),术毕所有眼均行硅油填充,术后随访12～26mo,观察眼压、视力、眼前节及眼后节情况。

结果：术后32眼(71%)视力提高,13眼(29%)视力未提高,BCVA≥0.05的有23眼,较术前有显著差异(χ²=16.80,P<0.01),39眼(87%)视网膜复位良好,2眼(4%)出现硅油依赖眼,7眼(16%)合并视网膜前增殖膜。术后1眼(2%)虹膜新生血管(INV)进展为新生血管性青光眼,4眼INV逐渐消退,但较术前差异无显著性(χ²=1.61,P=0.21)。术后出现一过性高眼压11眼(24%),一过性角膜水肿8眼(18%),前房纤维渗出6眼(13%),虹膜后粘连2眼(4%),前囊膜混浊13眼(29%)。

结论：对于PDRⅥ期合并白内障的患者,保留晶状体前囊膜的玻璃体切除术联合术中超全视网膜光凝是安全有效的,能提高术后视力,有效地复位视网膜。同时可能减少INV的发生。     

雷珠单抗玻璃体内注射对增生型糖尿病视网膜病变玻璃体切割术效果的影响

目的　探讨术前玻璃体内注射雷珠单抗对增生型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）患者行经平坦部玻璃体切割术（ｐａｒｓｐｌａｎａｖｉｔｒｅｃｔｏｍｙ,ＰＰＶ）效果的影响。方法　回顾性分析１５７例行ＰＰＶ的ＰＤＲ患者,分为ＰＰＶ术前７ｄ行玻璃体内雷珠单抗注射组（Ａ组）及未注射组（Ｂ组）。观察并比较两组ＰＰＶ术中医源性裂孔的发生、填充物应用和术后玻璃体再出血、高眼压及最佳矫正视力情况。结果　Ａ组患者术中医源性裂孔发生占５．６１％,术中填充物应用者占３８．２１％,术后玻璃体再出血者占１５．７３％,术后高眼压者占４３．８２％,治疗稳定后最佳矫正视力＞０．３者占５３．９３％;Ｂ组患者术中医源性裂孔发生占１４．８６％,术中填充物应用者占５５．４１％,术后玻璃体再出血者占３３．７８％,术后高眼压者占５９．４５％,治疗稳定后最佳矫正视力＞０．３者占２１．６２％,两组各项指标比较差异均有统计学意义（Ｐ＝０．０４、０．０２、０．００、０．０４、０．００）。结论　ＰＤＲ患者ＰＰＶ术前行玻璃体内雷珠单抗注射能减少术中医源性裂孔的发生及玻璃体腔填充物的应用,降低术后玻璃体腔再出血及高眼压发生的几率,并可使患者获得较好的术后视力。     

玻璃体切割术联合激光治疗PDR的疗效观察

目的：探讨玻璃体切割术与激光治疗在增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)中的联合应用价值。

方法：选取我院2009-03/2010-03收治的PDR患者89例116眼,随机将患者分为对照组(47例62眼)和研究组(42例54眼)。对照组患者采用玻璃体切割术治疗,研究组患者在对照组患者治疗基础上,联合眼内激光进行治疗。比较分析患者治疗前后最佳矫正视力变化情况, FFA检查结果以及治疗后并发症发生情况。

结果：与治疗前相比,对照组和研究组治疗后最佳矫正视力<0.1的患者比率明显减少,分别为40%和28%,最佳矫正视力0.5～1.0的比率明显提高,分别达到24%和41%,差别均具有统计学意义(P<0.05)。与对照组患者治疗后相比,研究组患者治疗后最佳矫正视力0.5～1.0的比率明显提高,黄斑水肿消退或部分消退比率明显提高,而黄斑水肿加重、视网膜渗漏以及玻璃体再次出血比率明显降低,差别均具有统计学意义(P<0.05)。

结论：玻璃体切割术联合激光是治疗PDR的有效方案,对患者术后视力的提高和并发症的降低具有积极的促进作用。     

23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普治疗增生型糖尿病视网膜病变(PDR)的疗效分析

目的 对比分析23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普对增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)疗效及手术相关并发症的影响.方法 回顾性分析南昌大学第二附属医院2015年1月至2016年2月收治的PDR患者42例(42眼)的资料,其中22例在行23G玻璃体切割术前1周于玻璃体内注射康柏西普0.05 mL(A组);另外20例在行23G玻璃体切割术完毕时于玻璃体内注射康柏西普0.05 mL(B组).观察两组患眼手术时间,术后玻璃体内出血情况,术中、术后其他指标及最佳矫正视力等的差异.结果 A组手术完成时间、电凝止血率、医源性裂孔发生率及术中出血率均低于B组.两组术后6个月视力比较差异无统计学意义(P＞0.05),但两组术前、术后视力相比差异均有统计学意义(均为P ＜0.05).术后早期玻璃体出血(≤1个月);A组有4眼(18.2％),B组有3眼(15.0％),两组相比差异无统计学意义(P＞0.05).术后晚期玻璃体出血(＞1个月);A组6眼(27.3％),B组未发现玻璃体内出血,两组相比差异有统计学意义(P＜0.05).随访期间A组有3眼因术后玻璃体再出血,需再次手术,再次手术率13.6％;B组有2眼术后发生牵拉性视网膜脱离,需再次手术治疗,再次手术率10.0％.视网膜激光光凝补充治疗:A组需(2.3±1.0)次,B组需(1.4±0.6)次,两组比较差异有统计学意义(P＜0.05).结论 23G玻璃体切割术中联合康柏西普治疗PDR可有效预防术后早晚期出血,为术后激光补充治疗提供有利条件,减少激光补充治疗次数;而术前联合康柏西普治疗PDR可缩短手术时间,减少术中并发症发生,降低术后早期出血率.     

糖尿病性视网膜病变的手术时机及疗效的探讨

目的　探讨增生性糖尿病性视网膜病变(PDR)的手术时机与疗效的关系。方法　我院1998年8月～2 0 0 3年8月间行玻璃体视网膜手术的增生性糖尿病视网膜病变44例(5 6眼) ,分为增生早期组(糖尿病视网膜病变合并玻璃体积血或既往曾作全视网膜光凝治疗) 2 4眼,增生晚期组(广泛血管纤维膜增生合并牵引性视网膜脱离) 3 2眼,进行回顾性分析。结果　经过3月～3年随访(平均11.3月) ,增生早期组2 4眼均有不同程度的视力改善,0 .3者2 0眼(83 .3 3 % ) ,最佳视力达1.0 ;增生晚期组15眼视力有所提高,最佳视力为0 .4,4眼视力下降(其中两眼继发新生血管性青光眼而黑目蒙)。结论　正确把握糖尿病PDR玻璃体切除术手术时机,同时玻璃体切除术中行足量有效的眼内光凝,才能提高疗效降低糖尿病眼病的致盲率。     

Surgical outcomes of epiretinal membrane removal after successful pars plana vitrectomy for retinal diseases

PURPOSE: To evaluate visual outcomes after a removal of an epiretinal membrane (ERM) secondary to rhegmatogenous retinal detachment (RRD), proliferative vitreoretinopathy (PVR), or proliferative diabetic retinopathy (PDR). METHODS: The medical charts of 51 consecutive patients who underwent PPV to remove an ERM were reviewed in an institutional setting. The preoperative best-corrected visual acuity (BCVA) was evaluated to determine if it was a possible predictor of the postoperative BCVA. The visual outcomes in the RRD, PVR, and PDR groups were compared. Follow-up periods ranged from 13 to 90 months (mean, 40.9 months). RESULTS: After the ERM was removed, the postoperative BCVA improved significantly by 0.471 logarithm of the minimum angle of resolution units for all groups (t = 8.99; P < 0.001). The postoperative BCVA improved by two or more lines in 43 eyes (84.3%). Patient age and the preoperative BCVA significantly correlated with the visual improvement (P = 0.0082 and P = 0.035, respectively). CONCLUSION: The BCVA improves after removal of an ERM following PPV for eyes with RRD, PVR, or PDR. Patient age and preoperative BCVA correlated with the visual improvement after the ERM removal.     

玻璃体腔注射雷珠单抗对增殖性糖尿病视网膜病变手术的影响

目的：评价增殖性糖尿病视网膜病变( proliferative diabetic retinopathy,PDR)患者行玻璃体切除术前玻璃体腔内注射雷珠单抗对手术的影响。
　　方法：回顾性病例分析。共计纳入2013-04/2014-08在北京协和医院眼科诊治的PDR患者52例52眼。试验组23眼在玻璃体切除术前6~14 d行雷珠单抗玻璃体腔注药0.5mg,对照组29眼单纯行玻璃体切除手术。对比两组患者手术时间、术中出血、医源性破孔、手术填充物类型、再次手术率,以及术前、术后、末次随访时的视力情况等。结果：手术时间：试验组70.52±26.18min,对照组99.45±27.75min,两组比较差异有显著统计学意义( t=-3.827,P=0.000);手术中出血：试验组5眼(21.7%),对照组19眼(65.5%),两组比较差异有显著统计学意义(χ2=9.892,P=0.002);术中医源性破孔：试验组3眼(13.0%),对照组15眼(51.7%),两组比较差异有显著统计学意义(χ2=8.479,P=0.004)。术中硅油填充：试验组8眼(34.8%),对照组19眼(65.5%),两组比较差异有统计学意义(χ2=4.854,P=0.028)。玻璃体腔注射后未发生相关并发症。两组术前视力、术后视力比较差异无统计学意义( t=-1.659,-0 .084;P=0 .103,0.933);两组末次随诊视力比较差异有统计学意义(t=-2.662,P=0.010)。末次随诊视力≥0.1,试验组20眼(86.9%),对照组16眼(55.2%)。
　　结论：玻璃体腔注射雷珠单抗辅助PDR玻璃体手术可以易化手术操作,退化新生血管,减少术中出血和医源性破孔的发生率,并且大大缩短手术时间,最终达到提高患者视力的目的。     

玻璃体切割手术治疗增生型糖尿病视网膜病变的疗效观察

目的 评估玻璃体切割手术治疗1型糖尿病(diabetes mellitus,DM)所致增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床疗效及并发症特点.方法 回顾性分析2010年1月至2016年1月于我院确诊为PDR并行玻璃体切割手术治疗的18例(28眼)小于30岁的1型DM患者的临床资料,观察术后视力改善程度及术中、术后并发症.结果 术后随访6 ～ 72(平均43.0)个月,23眼(82.1％)术后视力维持或改善,5眼(17.9％)视力下降,其中无光感2眼(7.1％);1次手术复位视网膜脱离12眼(92.3％);术中并发症为医源性视网膜裂孔3眼;术后并发症:前房炎症反应9眼,前房积血5眼,复发性玻璃体积血2眼,复发性视网膜脱离3眼,虹膜红变5眼,新生血管性青光眼4眼.结论 玻璃体切割手术可以很好地恢复年轻1型DM所致PDR患者的视网膜解剖结构及功能,术后新生血管相关性并发症重,需行充足全视网膜光凝及术前抗VEGF注药治疗.