TA玻璃体腔注射结合玻璃体切割术治疗PDR

目的:探讨曲安奈德(triamcinolone acetonide,TA)玻璃体腔注射联合玻璃体切割术治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的优点和并发症。方法:对36例48眼具有玻璃体积血的PDR眼,术前5～7d玻璃体腔内注入TA0.1mL(40g/L)后行玻璃体切割术,术中玻璃体腔内注入TA0.3～0.5mL以帮助辨认玻璃体后皮质。结果:炎症反应程度:有4眼(8%)术后瞳孔区可见少量渗出膜,术后5～7d渗出吸收;15眼(31%)房水闪辉,术后3～5d,房水闪辉消失。所有病例都没有发现手术后感染。视力改善情况:39眼(81%)视力较手术前有不同程度提高(大于2行),7眼(15%)手术后视力较术前没有改善。眼压变化:玻璃体腔注入TA前后平均眼压比较其差异没有显著性;手术后1wk内监测平均眼压比术前高,其差异有显著性。手术后第3mo和术前相比,其差异没有显著性。结论:TA玻璃体腔注射联合玻璃体切割在治疗PDR中有较好的效果,临床上没有严重的并发症。     

Intravitreal triamcinolone acetonide for florid proliferative diabetic retinopathy

Background The spectrum of ocular indications in which intravitreal injections of triamcinolone acetonide may be therapeutically useful has recently been expanding.Methods Prospective clinical interventional case study in a young adult male with florid proliferative diabetic retinopathy (FPDR).Results A greater reduction of retinal thickening and fluorescein leakage from retinal new vessels was observed in the right eye after intravitreal injection of triamcinolone followed by scatter panretinal photocoagulation (PKP) than in the left eye treated only by laser.Conclusion Intravitreal injection of triamcinolone acetonide may be a useful adjunct to scatter panretinal photocoagulation for FPDR.     

睫状体平坦部四切口玻璃体手术治疗严重增生性糖尿病视网膜病变

目的探讨睫状体平坦部四切口玻璃体手术治疗有广泛纤维血管膜增生的糖尿病视网膜病变（PDR）的临床效果。方法为病例对照试验。回顾性选择27例（28只眼）有广泛纤维血管膜增生的PDR Ⅵ期患者作为试验组,采用睫状体平坦部四切口玻璃体手术,双手进行眼内操作,如膜分离与切除,视网膜复位,眼内光凝硅油充填。选择同期有广泛纤维血管膜增生的PDR Ⅵ期患者30例（30只眼）作为对照组,由同一术者完成睫状体平坦部三切口玻璃体手术。结果试验组28只眼均顺利完成膜分离与切除,1只眼出现2个医源性视网膜裂孔。随访7～54个月,术后视网膜均复位,多数患者视力有不同程度提高。对照组2只眼有部分膜残留,3只眼出现4个医源性视网膜裂孔,随访12个月视网膜均复位,3只眼发生新生血管性青光眼。结论四切口玻璃体手术采用双手操作眼内剥膜,可明显提高手术效率,减少组织损伤,是治疗有广泛纤维血管膜增生的严重PDR的较好方法。（中华眼科杂志,2008,44：17—19）     

Visual course for proliferative diabetic retinopathy after pars plana vitrectomy

PURPOSE: To investigate retrospectively the visual course for proliferative diabetic retinopathy after pars plana vitrectomy. CASES AND METHODS: From January 2002 to December 2004, we operated 209 eyes with proliferative diabetic retinopathy. For this study, we selected 28 eyes in which the visual acuity could be followed for 6 months or longer after the vitrectomy. RESULT: The mean time period for reaching the best visual acuity after vitrectomy was 14.7 +/- 12.0 months. Depending on the type of diabetic maculopathy, the ischemic type, deposit type, and cystoid macular edema type required a mean time of 16 approximately 19 months. For the diffuse edema type, the mean was 9 months. It is significant that vitrectomy with triamcinolone acetonide (TA) resulted in visual improvement earlier than vitrectmy without TA (p value = 0.03).     

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     

玻璃体切割术联合曲安奈德治疗严重PDR患者的糖尿病性黄斑水肿

【摘要】 目的 探讨玻璃体切割术联合曲安奈德（TA）治疗严重增殖性糖尿病视网膜病变（PDR）患者糖尿病性黄斑水肿的疗效。设计 回顾性比较性病例系列。研究对象 2009年7月至2010年4月中南大学湘雅二医院连续实施玻璃体切割术的严重PDR患者25例（28眼）。方法 12例14眼在玻璃体切除术毕玻璃体内注射曲安奈德（IVTA）2 mg,为IVTA组;13例14眼仅做玻璃体切割,未注射TA,为对照组。用OCT等检查随访观察患者6个月。两组患者术前PDR复杂性评分无差异。主要指标 LogMAR最佳矫正视力、OCT黄斑中央厚度。结果 术后6个月,IVTA组LogMAR最佳矫正视力（0.76±0.45）显著优于对照组（1.20±0.50）（t=2.473,P=0.020）;IVTA组OCT黄斑中央厚度（266.92±50.23 μm）显著低于对照组（285.37±46.81 μm）（t=16.470,P=0.000）。结论 玻璃体切割术联合玻璃体内注射曲安奈德有利于控制严重PDR患者的糖尿病性黄斑水肿和提高视力。（眼科,2012,21：248-252）     

玻璃体切割术治疗增生性糖尿病视网膜病变中应用曲安奈德的止血作用及其机制

背景 临床发现玻璃体切割术治疗增生性糖尿病视网膜病变(PDR)术中应用曲安奈德(TA)有止血作用,但其机制并不清楚. 目的 探讨玻璃体切割术治疗PDR过程中眼内应用TA止血的作用机制.方法 采用前瞻性研究设计,于2011-2014年纳入在天津医科大学总医院眼科因PDR接受玻璃体切割术且术中眼内应用TA的患者12例12眼,作为TA组,同期因黄斑前膜或黄斑裂孔接受玻璃体切割术且未用TA的患者共32例32眼作为对照组,两组术眼在玻璃体切割术开始时均采集玻璃体样本0.6 ～0.8 ml.采用ELISA法分别测定TA组和对照组患者玻璃体中尿激酶纤溶酶原激活物(u-PA)、组织纤溶酶原激活物(t-PA)及纤溶酶原激活物抑制剂1(AI-1)含量,比较TA组和对照组术前玻璃体样本中上述指标含量的差异.结果 TA组术眼玻璃体中u-PA、t-PA和PAI-1平均质量浓度分别为25.45、127.44和0.42 ng/ml,对照组分别为22.94、142.37和0.27 ng/ml,TA组术眼玻璃体中u-PA平均质量浓度明显高于对照组,差异有统计学意义(Z=-2.268,P＜0.05),TA组和对照组术眼玻璃体中t-PA和PAI-1平均质量浓度的差异均无统计学意义(Z=-0.092、-1.847,均P＞0.05). 结论 PDR患者玻璃体中u-PA平均质量浓度高,易致眼内出血.玻璃体切割术中眼内应用TA可减少或阻止出血其机制可能与t-PA和u-PA平均质量浓度降低而达到降低出血倾向,并通过增加PAI-1质量浓度而发挥止血作用有关.     

玻璃体切除联合白内障手术治疗增生性糖尿病视网膜病变

目的探讨经睫状体平坦部闭合式玻璃体切除联合保留前囊晶状体超声乳化及后房型人工晶状体(PCIOL)植入(联合手术)治疗合并白内障的增生性糖尿病视网膜病变(PDR)的临床效果。方法回顾性分析合并不同程度白内障的PDR36例(39眼)实施联合手术,观察术后视力改善程度及术中、术后并发症。结果36例(39眼)成功地进行了联合手术。术后随访2月～3年半,平均13.4月。术后37眼(94.87%)视力不同程度提高,视力≥0.05者26眼(66.67%),≥0.1者17眼(43.59%),≥0.3者7眼(17.95%);视力下降2眼(5.13%)。术后视力低下者伴有糖尿病性黄斑水肿、硬性渗出或糖尿病性视神经病变。术中并发症包括晶状体核碎块致视网膜损伤3眼(7.69%)及前囊破裂2眼(5.13%);术后并发症包括玻璃体积血4眼(10.26%),角膜轻度水肿和一过性眼压升高各2眼(5.13%),后发障3眼(7.69%),虹膜红变和眼球萎缩各1眼(2.56%)。结论经睫状体平坦部闭合式玻璃体切除联合保留前囊晶状体超声乳化及PCIOL植入术较安全有效。     

玻璃体切除联合曲安奈德治疗增生性糖尿病视网膜病变

目的:评价玻璃体切除联合曲安奈德(triamcinolone acetonide,TA)球内注射治疗增生性糖尿病视网膜病变(proliferative diabetic refinopathy,PDR)的疗效。方法:分析本院因PDR住院治疗患者90例98眼,玻璃体切除术联合TA球内注射50眼和单纯行玻璃体切除术48眼,比较两组患者治疗前后的矫正视力、眼内炎症、反应眼压和眼底等情况。结果:随访至术后6mo。TA注射组术后前房炎症反应及黄斑水肿的发生率较单纯手术组降低,其差异有统计学意义(P<0.05),术后视力改善程度及眼压升高的发生率组间差异无统计学意义。结论:玻璃体切除联合TA球内注射治疗PDR与单纯玻璃体切除术比较,可以减少术后眼内炎症反应及黄斑水肿的发生。     

Intravitreal ranibizumab versus vitrectomy for recurrent vitreous haemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy: a prospective study

International Ophthalmology - To compare prospectively intravitreal ranibizumab treatment and pars plana vitrectomy (PPV) in patients with recurrent vitreous haemorrhage (VH) due to proliferative...     

影响增殖性糖尿病视网膜病变玻璃体切除术后视力改善的因素

目的:分析影响增殖性糖尿病视网膜病变(PDR)玻璃体切除术后视力改善的因素.方法:回顾性分析.收集2014-01/2014-12在马来西亚吉打州,亚罗士打Sultanah Bahiyah医院收治的PDR行玻璃体切除术病例资料,包括1y内患者统计,基线视力(VA)和LogMAR术后最佳矫正视力.使用IBM SPSS Statistics Version 22.0进行数据分析.结果:共103例患者.平均年龄51.2y.在多变量分析中,每个0 logMAR基线VA的1 logMAR术前正偏差与0.859 logMAR的术后改善相关(P<0.001).同样,术前附着的黄斑与玻璃体切除术后的logMAR视力改善相关(b=0.374,P=0.003).无虹膜新血管和无术后并发症与玻璃体切除术后改善的logMAR视力相关,分别为1.126(P=0.001)和0.377(P=0.005).无长效眼内填充与玻璃体切除术后logMAR视力改善相关,为0.302(P=0.010).结论:玻璃体切除术后与视力改善的相关因素是:术前视力较差,黄斑附着,无虹膜新生血管,无术后并发症和未使用长效眼内填充物.了解视力改善的因素将有助于玻璃体视网膜手术的决策.     

曲安奈德在玻璃体切割术中的临床应用

目的：探讨玻璃体切割术(PPV)中应用曲安奈德(Triamcinolone Acetonide, TA)识别玻璃体后皮质(PVC)且辅助有效清除残余玻璃体后皮质的临床意义。

方法：收集2009-03/2013-03行玻璃体切割术患者35例35眼,术中分次各注射TA 0.1mL。以帮助辨认玻璃体后皮质、视网膜前增殖膜、黄斑前膜,并有效清除。16例硅油填充,9例C₂F₆填充。术后随访6～12mo。

结果：所有病例经玻璃体腔TA注射后,明显改善玻璃体后皮质、视网膜前膜、内界膜的辨认情况。其中,13例为玻璃体后皮质残留,19例为玻璃体后脱离(posterior detachment of vitreous,PVD)。经过有效的清除后,黄斑裂孔闭合率100%。视网膜复位率84.6%。

结论：利用曲安奈德在玻璃体切割术中的良好可视性能有效识别玻璃体后皮质的残留、减少视网膜损伤、提高手术成功率。没有发现与TA有关的副作用。     

Epiretinal membrane formation after pars plana vitrectomy in proliferative diabetic retinopathy]

Recurrent epiretinal membranes are a major contributing factor to functional and visual failures after pars plana vitrectomy for proliferative vitreoretinal disorders. In this study 222 consecutive eyes that have had pars plana vitrectomy for proliferative diabetic retinopathy (operated in 1986 und 1987) were evaluated retrospectively. The study focuses on a subgroup of 108 consecutive eyes all with preoperative tractional retinal detachment and all operated with primary silicone oil injection. A minimum follow up of six months was present in 90% of these cases. Permanent visual success was observed in 40% of the eyes, most of which had dense vitreous hemorrhage preoperatively. Multivariant analysis revealed that among several potential risk factors recurrent epiretinal membranes as well as silicone oil were significantly associated with visual failure. Because of the high incidence of recurrent epiretinal membranes associated with poor functional results silicone oil injection following pars plana vitrectomy should be employed restrictively in patients with proliferative diabetic retinopathy.     

康柏西普和雷珠单抗联合玻璃体切除术治疗PDR的疗效比较

目的:比较两种抗VEGF药物康柏西普和雷珠单抗在增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者玻璃体切除术(pars plana vitrectomy,PPV)术中和术后的作用.方法:将2016-06/12于我科确诊为PDR伴有玻璃体出血(vitreous hemorrhage,VH)和/或牵引性视网膜脱离(tractional retinal detachment,TRD)的62例64眼41~59岁患者纳入研究,于PPV术前3d玻璃体腔注射抗VEGF药物0.50mg(0.05mL),无明显并发症后行标准23G微创巩膜三通道玻璃体切除术,记录并分析手术时间、术中出血、医源性视网膜裂孔、眼内电凝使用、是否硅油填充等,对术前及术后1mo视力及黄斑厚度进行对比,观察术后并发症情况.结果:两种抗VEGF药物预处理对手术时间、术中出血、医源性视网膜裂孔、眼内电凝使用、是否硅油填充及术后玻璃体二次出血发生率均无明显统计学差异,且二者均可提高PPV术后视力,减低术后黄斑厚度.结论:康柏西普和雷珠单抗二者效果相似,预处理联合PPV可提高患者术后视力,改善黄斑水肿,可根据患者实际情况灵活选择.     

增生型糖尿病视网膜病变微创玻璃体切割手术后新生血管性青光眼的危险因素分析

目的分析增生型糖尿病视网膜病变(PDR)25G玻璃体切割手术(PPV)后发生新生血管性青光眼(NVG)的危险因素。方法回顾性病例研究。2017年1月至2018年12月在天津医科大学眼科医院首次行PPV治疗的PDR合并玻璃体积血(VH)患者340例340只眼纳入研究。其中,男性185例,女性155例;平均年龄(55.79±10.82)岁。患者平均糖尿病病程(13.01±7.70)年;平均空腹血糖(7.55±2.15)mmol/L。合并冠心病19例,合并脑梗死20例。所有患眼均行最佳矫正视力(BCVA)、眼压、间接检眼镜、彩色眼底照相等检查。BCVA检查采用国际标准Snellen视力表进行,并将结果换算为最小分辨角对数(logMAR)视力记录。患眼平均logMARBCVA2.04±0.73,平均眼压(15.45±2.93)mmHg(1 mmHg=0.133kPa)。VH持续时间3周?6个月,平均时间(2.98±1.46)个月。340只眼中,Ⅳ期93只眼(27.35%),Ⅴ期107只眼(31.47%),Ⅵ期116只眼(34.12%);伴牵引性视网膜脱离(TRD)83只眼。所有患眼均行25G标准经睫状体平坦部三通道PPV。57只眼手术前3d行玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗,234只眼手术中剥除内界膜,262只眼同时行白内障超声乳化手术,141只眼手术完毕时行玻璃体腔注射抗VEGF药物治疗。手术后随访至少12个月,平均随访时间(10.80±5.79)个月。以裂隙灯显微镜或房角镜检查发现虹膜和(或)房角存在新生血管且眼压〉21mmHg者诊断为NVG。采用Kaplan-Meier法和Cox单因素、多因素回归分析手术前基线因素、眼部因素、手术因素与手术后NVG发生的关系。结果340只眼中,PPV后发生NVG者66只眼(19.41%);发生NVG的时间为手术后6?335 d,平均时间为(98.00±5.79)d。PPV后第3、6、12个月,NVG发生风险比分别为11.50%、15.29%、20.75%。单因素Cox分析结果表明,年龄、合并冠心病或脑梗死疾病等手术前基线因素对手术后发生NVG有影响(P<0.05);PDR分期、合并TRD、手术前logMAR BCVA、手术前眼压等眼部因素对手术后发生NVG无影响(P>0.05);联合白内障超声乳化手术、手术中剥除内界膜、手术前3d玻璃体腔注射抗VEGF药物等手术因素对手术后发生NVG有影响(P<0.05)。将Cox单因素分析有意义的变量纳入多因素Cox比例风险模型进行分析,逐步回归探索手术后NVG的影响因素。结果显示,年龄、合并冠心病或脑梗死、联合白内障超声乳化和手术中内界膜剥除是手术后发生NVG的独立风险预测因素(P<0.05)。结论低龄、合并冠心病或脑梗死、联合白内障超声乳化手术是PDR患者PPV后发生NVG的危险因素,手术中剥除内界膜可减少NVG的发生。     

Pars plana vitrectomy in proliferative diabetic retinopathy

In this contribution the authors present the results of treatment by pars plana vitrectomy in a consecutive series of 200 patients with proliferative retinopathy. Anatomical success was achieved in 82% of the cases of simple vitreous hemorrhages, in 63% and 67% respectively of the cases of traction detachment with or without vitreous hemorrhage, and in 55% of the cases of combined rhegmatogenous and traction detachment. Postoperative visual success was generally dependent on preoperative macular findings. Visual success was achieved in 71% of cases where the macula was attached preoperatively, as opposed to only 38% of the patients in whom it was preoperatively detached. Intraoperative retinal complications were less than 1% in cases of simple vitreous hemorrhage, rose to 13%-15% in cases of traction detachment and were quite common (32%) in cases of combined rhegmatogenous and traction detachment. A major goal of this paper was to show that anatomical and visual success as well as intraoperative complications were highly dependent on the degree of surgical difficulty and the stage of the disease. The results support the concept that vitreous surgery should be considered early in the late stages of proliferative diabetic retinopathy.     

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)     

Problems in pars plana vitrectomy in complicated diabetic retinopathy

Introduction summarizes basal indications for pars plana vitrectomy (PPV) in complicated diabetic retinopathy (DR) and indications for urgently performed PPV are accentuated. Further there are explained various peculiarities of PPV in DR, various components forming the solution for infusion, advantages of the cerclage, some problems with surgery of the complicated cataracts, contribution and indications of the use of the silicone oil for the inner tamponade. Special attention was paid to the postoperative complications affecting the cornea, rubeosis iridis, iatrogenic tears of the retina and recurring intravitreal hemorrhages. Thereafter author concludes this review evaluating prognosis and long-term results of PPV and DR. He emphasizes the technical difficulties of this operation and recommends to concentrate the performance of this operation into the centres specialized for vitreoretinal surgery.     

严重PDR玻璃体切割术后雷珠单抗注射的效果观察

目的：对严重增殖性糖尿病视网膜病变的患者行玻璃体切割术后行雷珠单抗注射的效果观察。方法：回归性分析。12例严重增殖性糖尿病视网膜病变患者(12眼)接受睫状体平坦部玻璃体切割术,同时给予硅油、惰性气体或者平衡液的玻璃体腔填充。在手术结束的同时给予雷珠单抗的玻璃体腔注射。结果：随访时间平均为2.75 mo。这12眼中分别包括玻璃体积血(1眼);玻璃体积血伴纤维血管化增生(1眼);玻璃体积血伴牵拉性视网膜脱离(3眼);纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴纤维血管化增生伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴牵拉性孔源性视网膜脱离(1眼)。12眼中,8眼行玻璃体腔硅油填充,2眼行惰性气体填充,2眼行平衡液填充。所有的患者之前均未接受任何治疗。视网膜脱离复位率为10/10(100%)。1眼术后出现前房积血。9眼术后最佳矫正视力较术前提高,2眼无明显变化,1眼较术前下降。 OCT检查显示8眼术后未见黄斑水肿。结论：玻璃体切割术后雷珠单抗注射对严重增殖性糖尿病视网膜病变患者有明显的治疗效果：手术成功率明显提高;患者视力显著提高;糖尿病黄斑水肿的发生概率减少;术中及术后并发症的发生率降低。