23G微创玻璃体切割手术治疗糖尿病视网膜病变的疗效

目的比较23G与20G微创玻璃体切割手术治疗糖尿病视网膜病变(PDR)的临床效果。方法选择该院眼科2012年1月—2013年12月期间收治的糖尿病视网膜病变患者89例,根据手术方式不同分为23G(48例,52眼)和20G组(41例,47眼),23G组采用23G微创玻璃体切除手术进行治疗,20G组采用微创玻璃体切除手术进行治疗,术后1个月、3个月以及6个月随访,比较两组手术时间及术中并发症,术后1个月、3个月以及6个月随访,比较两组术后视力以及眼压。结果两组术后视力均明显优于术前,差异有统计学意义(P0.05);两组术后1个月、3个月以及6个月视力以及术前术后眼压比较,差异无统计学意义(P0.05)。结论 23G微创玻璃体切割手术治疗糖尿病视网膜病变能够取得比较满意的临床效果,且不良反应较少,可以在临床上推广应用。     

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.     

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。     

雷珠单抗对增殖性糖尿病视网膜病变患者行玻璃体切割术的影响及护理

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)行玻璃体切割手术治疗效果的影响,探讨有效的护理方法。方法 PDR患者70例(70眼),随机分为实验组35例(35眼)和对照组35例(35眼)。实验组玻璃体腔内注射雷珠单抗0.5 mg,行玻璃体切割术;对照组直接行玻璃体切割术。两组患者均做好术前、术后护理及术后随访。结果实验组平均手术时间、术中出血及医源裂孔、填充硅油发生率均低于对照组(P0.05);两组术后视力均得到提高,实验组脱盲率高于对照组,两组比较差异有统计学意义(P0.05)。玻璃体腔注射后未发生相关并发症。结论 PDR患者在玻璃体切割术前注射雷珠单抗可减少手术中的出血量,提高术野的清晰度,缩短手术时间,减少医源性裂孔及填充硅油的发生,避免术后并发症。系统而有效的护理对完成整个治疗及获得更好的术后视力具有重要的意义。     

增殖性玻璃体视网膜病变的研究进展

增殖性玻璃体视网膜病变（PVR）是指孔源性视网膜脱离长期未复位或视网膜脱离复位术后,无血管的纤维细胞性膜在玻璃体腔及视网膜内外表面形成和收缩所致的一类病变。PVR是常见的致盲性眼病之一,也是孔源性视网膜脱离复位手术失败及术后复发的主要原因。现将近年来其相关研究进展概述如下。1PVR发生、发展的影响因素     

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。     

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.     

探讨两种PRN治疗方案下康柏西普治疗糖尿病视网膜病变的临床疗效

目的 本研究旨在比较在两种按需治疗（pro re nata,PRN）方案下,康柏西普治疗糖尿病视网膜病变（diabetic retinopathy,DR）的临床疗效。方法 回顾性分析2019年1月—2023年6月广西中医药大学第一附属医院东葛院区眼科DR患者40例（80眼）,并根据按需治疗方案,分为1+PRN组及3+PRN组,每组20例（40眼）。1+PRN即康柏西普首月注射1针,后根据眼底情况每月按需治疗;3+PRN即康柏西普连续3个月每月注射1针,后每月按需治疗。对比两组治疗有效率、治疗前和治疗半年后的视力、黄斑中心凹厚度及不良反应率。结果 两组总有效率分别为90.0%和92.5%比较差异无统计学意义（P>0.05）。两组患者治疗前、治疗半年后视力、黄斑中心凹厚度对比,差异无统计学意义（P>0.05）。1+PRN组中发生高眼压1眼,视网膜脱离1眼及玻璃体积血2眼,两组患者不良反应发生率比较,差异无统计学意义（P>0.05）。结论 康柏西普治疗DR具有明显的临床效果,且两种方案疗效相似,因此,均可选择3+PRN方案或1+PRN方案进行治疗,且两组发生不良反应率低。     

Clinical efficacy of intravitreal aflibercept injection versus vitrectomy with panretinal photocoagulation for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis

Background:In the current literature, it is still controversial whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) patients. Given that there is no high-quality meta-analysis or review to incorporate existing evidence, the purpose of this study is to systematically review the level I evidence in the literature to ascertain whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with PRP for PDR patients.Methods:The systematic literature review is structured to adhere to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), which include requirements deemed essential for the transparent reporting of results. A systematic search will be performed in Web of Science, Embase, Scopus, Science Direct, Cochrane Library up to and inclusive of March 19, 2021. The method of data extraction will follow the approach outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome is change in best-corrected visual acuity. The secondary outcomes are change in area of neovascularization and change in area of retinal nonperfusion. Where disagreement occurs, this will be resolved through discussion. All outcomes are pooled on random-effect model. A P value of < .05 is considered to be statistically significant.Results:The results of our review will be reported strictly following the PRISMA criteria.Conclusions:The hypothesis of the study was that visual acuity recovery would be faster with vitrectomy because the blood is mechanically cleared during surgery.Registration number:10.17605/OSF.IO/NCAXW.     

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.     

增殖型糖尿病视网膜病变玻璃体手术与虹膜红变发生的关系

目的探讨增殖型糖尿病视网膜病变(PDR)行玻璃体手术后,虹膜红变(INV)发生的危险因素。方法对451例PDR(536眼)行玻璃体手术治疗后INV的发生进行多因素logistic回归分析。结果44眼(8.2%)发生INV,12眼(2.2%)出现新生血管性青光眼;以术后1个月到半年时间段内INV发生率最高(48.3%)。Logistic回归分析显示术前即存在INV和一次术后视网膜是否复位这两个因素与PDR患者玻璃体手术后INV的发生相关(P<0.001);PDRⅣ、Ⅴ、Ⅵ期发生率比较接近(分别为8.5%,6.1%,9.0%);术前完成全视网膜光凝的患者发生术后INV的比例更低(6.2%vs9.9%)。晶体状态为保留自身晶体的患者INV发生率最低(6.8%),与人工晶状体植入后囊完整组(8.9%)相比,差异无统计学意义(P=0.525)。结论术前合并INV和一次术后视网膜脱离是术后INV发生的主要危险因素。PDR严重程度与INV发生没有明显关系。     

Comparison of vitrectomy alone and combined vitrectomy, phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy

There have been concerns that there may be an increased incidence of iris neovascularization (NV) following lens removal in patients with proliferative diabetic retinopathy (PDR). In this study, we retrospectively compared vitrectomy alone and vitrectomy combined with phacoemulsification (phacovitrectomy) and intraocular lens implantation regarding both complications and results. Fifty-three eyes for vitrectomy group and 31 eyes for phacovitrectomy group were included. Postoperative iris and angle NV were found in eight (15.1%) eyes in the first group and no (0%) eyes in the second. The incidence was significantly lower (p < 0.05) in the phacovitrectomy group. The final vision gain of one or more lines was found in 17 (32.1%) and 21 (67.7%) eyes, respectively. There was significantly better vision improvement in the phacovitrectomy group. We consider the combined procedure to be useful as an alternative surgical treatment for patients with PDR and cataract formation.     

普拉洛芬联合美多丽在增生性糖尿病视网膜病变玻璃体切割手术中对瞳孔大小的影响

［摘要］　目的　观察普拉洛芬联合美多丽在增生性糖尿病视网膜病变玻璃体切割手术中对瞳孔大小的影响。方法　选取2020年4月至2021年5月因增生性糖尿病视网膜病变在贵阳市第一人民医院眼科行玻璃体切割手术的患者89例（126眼）,按照随机数字表法分为观察组和对照组各63眼。观察组抗血管内皮生长因子（VEGF）术后第1天开始使用普拉洛芬,连续用药3 d,并在术前30 min使用美多丽散瞳;对照组抗VEGF术后,仅术前30 min使用美多丽散瞳。分别在手术前、术中1 h、手术结束时（≥2 h）测量瞳孔大小,比较两组各时间点的平均瞳孔面积大小。结果　观察组各时点平均瞳孔面积均大于对照组,差异有统计学意义（P<0.05）。两组术中1 h平均瞳孔面积与术前比较差异均无统计学意义（P>0.05）。两组手术结束时（≥2 h）平均瞳孔面积均低于术前,差异有统计学意义（P<0.05）,但观察组平均瞳孔面积缩小程度小于对照组,差异有统计学意义（P<0.05）。结论　普拉洛芬可以有效抑制增生性糖尿病视网膜病变玻璃体切割手术中瞳孔缩小,联合美多丽使用可以维持术中长时间散瞳状态,给手术创造良好的视野。     

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。     

Clinical efficacy and acceptability of panretinal photocoagulation combined with conbercept for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis

Background:Although conbercept has been used for other diseases associated with new vascular formation, the effect of single-dose conbercept in combination with proliferative diabetic retinopathy (PDR) have not been established. We thus conducted this protocol for systematic review and meta-analysis to compare the efficacy and acceptability of panretinal photocoagulation (PRP) associated with intravitreal conbercept injections versus PRP alone in the treatment of patients with PDR.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines and the recommendations of the Cochrane Collaboration were followed to conduct this study. Reviewers will search the PubMed, Cochrane Library, Web of Science, and EMBASE online databases using the key phrases “panretinal photocoagulation,” “conbercept,” and “proliferative diabetic retinopathy” for all cohort studies published up to May 2021. The studies on cohort study focusing on PRP + conbercept and PRP alone for PDR patients will be included in our meta-analysis. At least one of the following outcomes should have been measured: PRP completion rate, proportion of eyes with visual gain/loss, central macular thickness, and incidence of complication. Review Manager software (v 5.4; Cochrane Collaboration) is used for the meta-analysis.Results:It was hypothesized that intravitreal conbercept plus PRP was more effective than PRP alone.OSF registration number:10.17605/OSF.IO/HCQ2S.     

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.