视盘新生血管型糖尿病视网膜病变的治疗

新生血管生长于视盘上的糖尿病视网膜病变较生长于视网膜其他部位的糖尿病视网膜病变（简称糖网）更具危险性，它常常引起玻璃体出血和牵拉性视网膜脱离，导致视力严重丧失。对于此型糖网。目前国内外已广泛采用激光治疗。对于玻璃体出血和牵拉性视网膜脱离者，可采用激光联合玻璃体切割术。我们对我院2000年1月～2005年1月治疗的一组病人进行了总结，现报告如下。     

糖尿病患者视网膜前新生血管膜中血管内皮细胞的增殖和激活

目的 研究Ⅰ型糖尿病患者增殖型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)视网膜前新生血管膜中血管内皮细胞的增殖和激活状态。 方法用双重免疫荧光及碱性磷酸酶抗碱性磷酸酶法检查Ⅰ型糖尿病患者18例PDR视网膜前新生血管膜血管内皮细胞的增殖和激活状态，并与患者的主要临床特征相比较。 结果 18例标本中,16例(88.9%)含增殖状态的血管内皮细胞，14例(77.8%)的内皮细胞呈激活状态;应用双重染色技术,发现在含增殖状态内皮细胞的16例中有14例(87.5%)内皮细胞同时处于激活状态。 结论 PDR视网膜前新生血管膜中大多数新生血管内皮细胞呈增殖和激活状态，提示血管内皮细胞在PDR的病理生理和发展中起重要作用。(中华眼底病杂志,1998,14:141-143)     

有/无填充物微创玻璃体切割术治疗增生性糖尿病视网膜病变合并牵拉性视网膜脱离的疗效比较

目的　比较有／无填充物的微创玻璃体切割术治疗增生性糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）合并牵拉性视网膜脱离的疗效。方法　回顾性分析２０１０年１月至２０１３年１月我院收治的ＰＤＲ合并牵拉性视网膜脱离患者的临床资料,所有患者均采用微创玻璃体切割术治疗,根据术中是否进行玻璃体填充分为无填充物组（Ａ组）和有填充物组（Ｂ组）。术后随访３个月以上,比较两组患者的一般资料（包括性别、年龄、血糖、糖尿病病程等）、手术前后眼压、视力以及术后并发症等。结果　本研究共入组８０例（８０眼）患者,其中Ａ组患者４２例,Ｂ组患者３８例。２组患者术前、术后７ｄ、术后１个月的眼压比较,差异均无统计学意义（均为Ｐ＞０．０５）。２组患者术前、术后３个月的视力比较,差异均无统计学意义（均为Ｐ＞０. ０５）,而Ａ组术后１个月时的视力高于Ｂ组,差异有统计学意义（Ｐ＜０．０５）。术后Ａ组２例患者出现低眼压,１例出现玻璃体积血;Ｂ组２例患者出现玻璃体积血,２例出现晶状体混浊,１例出现低眼压;２组患者术后并发症发生率差异无统计学意义（χ２ ＝０．８０２,Ｐ＝０．３７）。结论　ＰＤＲ合并牵拉性视网膜脱离患者采用微创玻璃体手术治疗可取得较好的疗效,且无填充物患者术后视力恢复更快。     

糖尿病视网膜病变视盘新生血管膜的分类及处理

目的 探讨视盘新生血管膜的分类及糖尿病视网膜病变(diabeticretinopathy,DR)手术中,不同类型新生血管膜的处理和预后.方法 回顾分析2000年11月至2006年2月手术的有随访记录的增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者139例(148只眼),术前均行眼部超声检查,行标准的三切口玻璃体切割术.术中钝性剥膜配合电凝止血处理新生血管膜.结果 视盘新生血管膜的发病率75%(111/148只眼)大部分患者视力较术前有不同程度的提高,视力改善率86.5%.视盘新生血管膜有二种来源三种类型,不同类型的膜在B超图像上有不同的表现.膜基本都能够被完整剥离,但不同类型的膜因其与视盘及周围视网膜粘连程度不同,其剥离难易不同,且有不同的出血倾向.结论 PDR视盘新生血管膜存在二种来源三种类型,在手术中视盘部的新生血管膜大多能被剥离,术前超声了解其分类可估计手术难度及预后.复杂的易反复出血的患者宜采用硅油作为眼内填充.     

玻璃体视网膜联合手术治疗伴玻璃体积血的牵拉性视网膜脱离

本文创用玻璃体视网膜联合手术方法,对29例伴周边部增殖性玻璃体视网膜病变的非糖尿病性玻璃体积血进行治疗。根据术前B 超形态学检查和玻璃体手术中直视观察,判断增殖病变的部位,同时采用对抗增殖区放射状牵拉点和缓解玻璃体基底部环状收缩的治疗原则,将网脱型玻璃体积血手术治愈率和总治愈率分别提高至82.8%和94.1%,大大减少了医源性并发症。这种手术方法对眼组织损伤小、操作简单、疗效确切,基本上解决了因牵拉性视网膜脱离导致的玻璃体手术失败。     

糖尿病视网膜病变新生血管程度与眼轴长度的关系

目的 观察2型糖尿病合并增殖期糖尿病视网膜病变(PDR)患者的视网膜新生血管程度与眼轴长度的相关性.方法 随机抽取Ⅳ期PDR患者22例(29只眼),平均年龄(54.01±6.81)岁,Ⅴ期PDR患者26例(32只眼),平均(55.50±8.43)岁,Ⅵ期PDR患者30例(36只眼),平均(52.09±7.19)岁.随机抽取体检的正常人15例(30只眼)为对照组,平均(52.68士8.95)岁.应用眼科A/B超声诊断仪测量眼轴长度.结果 PDR各期眼轴长度＜24mm者所占的比例均高于眼轴长度≥24mm者;PDR的Ⅳ期眼轴长度(23.13±0.72)mm、Ⅴ期眼轴长度(22.55±0.76)mm、Ⅵ期眼轴长度(22.33±0.51)mm与正常对照组眼轴长度(23.39±0.83)mm之间差异均有统计学意义(P＜0.05);PDR视网膜新生血管程度与眼轴长度之间存在相关性(x2=16.64,P＜0.05;r=0.39).结论 2型糖尿病合并PDR的视网膜新生血管程度与眼轴长度之间存在相关性,可以为研究PDR视网膜新生血管的机制及防治提供依据.     

孔源性视网膜脱离后视网膜新生血管的实验研究

目的：观察孔源性视网膜脱离（RRD）后新生血管的形成及形态学改变。方法：采用玻璃体手术制备25只眼RRD模型,排除失败的5只眼后,将20只眼分为5组,每组4只兔（眼）。分别在RRD第1,4,7,14和28天,观察新生血管的形态学改变。结果：RRD1和4天,未见新生血管。7天可见视备用新生血管。14天眼底荧光造影可见新生血管末梢渗漏。但主干枝无渗漏。14-28天,以视盘为中心的新生血管范围逐渐扩大,部分新生血管已发育成熟。虹膜无新生血管形成。结论：随着RRD时间的延长,视网膜新生血管范围逐渐扩大,并逐渐发育成熟,新生血管是一种视网膜缺氧的代偿性反应。     

中西医结合治疗糖尿病性视网膜新生血管病变

〕目的：为了更好地探讨治疗糖尿病性视网膜病变的方法。方法：对３４例糖尿病性视网膜新生血管病变进行随机分组治疗，两组控制血糖及辅助治疗用药相同，治疗组加服本院自拟眼底滋阴汤，滋阴活血治疗。结果：治疗组总有效率７０．５９％，对照组总有效率３５．２９％，两者差异有显著意义（Ｐ＜０．０５）。结论：提示中西医结合治疗本病较西医治疗有一定的优越性     

Surgical outcome of full-thickness macular hole secondary to tractional retinal detachment in proliferative diabetic retinopathy

Purpose:To evaluate the surgical outcome of full-thickness macular hole (FTMH) secondary to active fibrovascular proliferation (FVP) and tractional retinal detachment (TRD) in eyes with proliferative diabetic retinopathy (PDR), and factors influencing the outcome.Methods:This retrospective study included the patients who underwent vitrectomy for FTMH secondary to PDR TRD from 2016 to 2020. Anatomical and visual outcomes were analyzed after six months along with the factors predicting the final outcome and duration of subretinal fluid (SRF) resolution.Results:Group A (macula-off combined RD, i.e., tractional and rhegmatogenous) included 10 eyes, while group B (macula-threatening TRD) included eight eyes. The mean best-corrected visual acuity improved from logMAR 1.21 (Snellen equivalent: 20/324) to logMAR 0.76 (Snellen equivalent: 20/115) (P = 0.008). Seventeen patients gained ≥1 line(s) of vision. Mean visual gain in groups A and B was 3.7 ± 1.9 and 1.9 ± 1.1 lines, respectively (P = 0.051). MH closed in 88.9% eyes. Type 1 anatomical closure was achieved in 88.9% of eyes. At 6 months, SRF and central macular thickness reduced from 479.6 ± 512.5 μm to 11.4 ± 23.5 μm (P = 0.002) and 874.3 ± 422.6 μm to 207.6 ± 81.7 μm (P = 0.0002), respectively. Finally, macular SRF resolved in all the patients. The mean duration for complete SRF resolution was 4.9 ± 3.2 months. Eyes with a shorter duration of diabetes mellitus (rho = −0.49, P = 0.040) and macula-off combined RD (P = 0.048) took a longer time for complete SRF resolution.Conclusion:Good anatomical and visual outcomes can be achieved in eyes with PDR TRD-associated FTMH. The residual macular SRF resolves slowly after the surgery and extra intervention is not required. Macula-off combined RD is associated with worse outcome and a slower SRF resolution rate.     

增殖性糖尿病视网膜病变虹膜新生血管的多模态临床研究

目的 探讨增殖性糖尿病视网膜病变(PDR)伴虹膜新生血管患者行虹膜血管造影图像的特征.方法 选取2017年9月至2018年12月就诊于首都医科大学附属北京同仁医院眼科中心及首都医科大学教学医院石景山医院眼科确诊为增殖性糖尿病视网膜病变患者32例(64只眼)的临床资料进行研究.检查并记录患者的年龄、糖尿病病程、眼压及视力...     

The outcomes of pars plana vitrectomy without endotamponade for tractional retinal detachment secondary to proliferative diabetic retinopathy

AIM: To evaluate the outcomes of pars plana vitrectomy (PPV) without the use of an ocular tamponade in patients having tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR).METHODS: It was an interventional study conducted at the Department of Ophthalmology, B.V. Hospital, Bahawalpur, Pakistan, from July 2011 to July 2012. A total of 75 patients (84 eyes) having TRD secondary to PDR were treated by PPV without using an ocular tamponade. All patients included in the study had a tractional retinal detachment secondary to proliferative diabetic retinopathy but didn’t have or develop retinal breaks before or during the study period. The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina. The mean follow-up period was 12 months.RESULTS:Successful retinal reattachement was observed in 78 of the operated eyes (92.8%). In these patients, the retina remained attached till the end of the one year follow-up period. Improvement in best corrected visual acuity (BCVA) was seen in 63 eyes (75%). The visual acuity remained unchanged in 9 eyes (10.7%). Mean improvement in BCVA was 2.00+1.24 at baseline to 1.24+1.22 (P<0.05) at the end of the follow-up period.CONCLUSION: In the absence of the retinal breaks, a TRD secondary to PDR can be successfully treated by pars plana vitrectomy without the use of an ocular tamponade.     

Subfoveal fluid resolves slowly after pars plana vitrectomy for tractional retinal detachment secondary to proliferative diabetic retinopathy

PURPOSE: To report delayed visual recovery resulting from slow resolution of subfoveal subretinal fluid measured with optical coherence tomography (OCT) after pars plana vitrectomy (PPV) for repair of tractional retinal detachment (TRD) involving the fovea secondary to proliferative diabetic retinopathy (PDR). METHOD: In this retrospective case series, charts of three patients with persistent subfoveal fluid after PPV for TRD secondary to PDR were reviewed. All patients were followed up for a minimum of 1 year after surgery, using OCT and serial ophthalmic examination. RESULTS: Subfoveal fluid resolved completely after a minimum of 6 months after PPV as measured by OCT. All three patients had improvement in visual acuity after subfoveal fluid was completely resolved. CONCLUSION: Persistent subfoveal fluid may take several months to resolve in patients undergoing PPV to repair TRD secondary to PDR and account for delayed visual recovery. OCT is an important tool in the follow-up of patients undergoing vitrectomy for TRD.     

Risk of retinal neovascularization in the second eye in patients with proliferative diabetic retinopathy

Purpose: This study aimed to evaluate the risk of proliferative diabetic retinopathy (DR) in the fellow eye of an eye with existing proliferative DR. Methods: Our DR screening programme database listed 1513 diabetes patients alive at the time of the study. Seventy‐six had proliferative DR in one or both eyes. Results: In 28 of the 76 (37%) diabetes patients, proliferative DR was diagnosed in both eyes at the same examination. Another 28 patients developed proliferative DR in the second eye within 5 years of its diagnosis in the first eye, bringing the total number of diabetes patients with proliferative DR in both eyes at 5 years to 56 (74%). Almost all the diabetes patients eventually developed proliferative DR in the second eye. The median duration of diabetes before the development of proliferative retinopathy was 19 years for type 1 and 14 years for type 2 diabetes. Conclusions: Proliferative DR is a bilateral disease. Diabetes patients with proliferative DR in one eye are at high risk of developing neovascularization in the second eye and close follow‐up is recommended.