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。     

Bevacizumab在增生期糖尿病视网膜病变患者81例手术前应用的疗效

糖尿病性视网膜病变(DR)在发达国家是致盲的前三位因素之一.目前对于DR的治疗,非增生期主要是应用药物和眼底激光光凝术,当DR进入增生期时,玻璃体手术成为主要的治疗手段.然而,由于糖尿病引起的微血管病变,手术时眼底极易出血,不但明显增加了手术难度,还会造成手术后新的渗出膜形成和牵拉,降低手术成功率,目前尚无有效减少术中及术后出血的方法.我们发现,术前应用Bevacizumab玻璃体腔内注射可明显减少手术中及术后出血,为DR提供更好的治疗方法.     

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...     

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。     

玻璃体切割联合眼内光凝治疗黄斑裂孔性视网膜脱离

黄斑裂孔性视网膜脱离是严重的致盲眼疾之一 ,目前尚无特效治疗方法 ,1999年 5月至 2 0 0 0年 9月 ,我们对 5例此病患者采用玻璃体切割联合眼内光凝黄斑裂孔底部视网膜色素上皮进行治疗 ,取得良好效果 ,现报告如下。临床资料 :本组 5例 ( 6眼 )中 ,男 1例 ( 2眼 )、女 4例 ( 4眼 ) ;年龄 5 1～ 65岁 ,平均 5 8岁 ;病程 0 .5～ 4个月 ;6眼均为高度近视黄斑裂孔性视网膜脱离 (黄斑白孔除外 ) ,按 1983年美国视网膜学会对增生性玻璃体视网膜病变 ( PVR)的分极方法 ,B级 4眼、C1级 2眼 ,可见黄斑前增殖膜 3眼 ;黄斑裂孔 <1/3视盘直径 ( PD) 5…     

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。     

老年糖尿病视网膜病变玻璃体切割术后患者的睡眠质量及其影响因素

目的探讨糖尿病视网膜病变(DR)玻璃体切割术后老年患者睡眠质量情况及其影响因素。方法采用匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)、自制睡眠质量影响因素调查表对206例玻璃体切割术后老年患者进行调查。结果玻璃体切割术后DR患者睡眠状况总均分为(10.18±3.23)分,且与术后焦虑评分呈正相关(r=0.453,P<0.001)。多元线性回归分析显示,卧位改变、焦虑、疼痛、血糖值是DR老年患者睡眠质量的影响因素。结论 DR玻璃体切割术后老年患者睡眠质量较差,并受身心、社会等方面的综合影响。     

康柏西普玻璃体腔注射辅助25G玻璃体切割手术治疗增殖性糖尿病视网膜病变的疗效观察

目的观察康柏西普玻璃体腔注射辅助25G玻璃体切割手术治疗增殖性糖尿病视网膜病变(PDR的疗效。方法回顾性分析52例(52眼)需行玻璃体切割的PDR患者临床资料,按手术前7 d是否行玻璃体腔注射康柏西普分为治疗组25例(25眼)和对照组27例(27眼)。治疗组在术前7 d予以康柏西普玻璃体腔注射,对照组术前不给予康柏西普注射,两组均行相同的25G微创玻璃体切割手术治疗。观察比较两组患者手术时间、术中并发症和术后3个月最佳矫正视力(BCVA)差异。结果治疗组手术时间、术中出血数、术中电凝数、医源性视网膜损伤数、硅油填充数均显著少于对照组(P 0.05)。治疗组术后3个月BCVA显著优于对照组(P 0.05)。两组均无其他全身不良反应。结论术前7 d给予玻璃体腔注射康柏西普辅助治疗,能有效减少25G微创玻璃体切割术治疗PDR的手术时间和术中并发症,并改善术后视力。     

全视网膜冷凝术治疗糖尿病性玻璃体溢血疗效观察

近年来,我们应用全视网膜冷凝术（ＰＲＣ）治疗糖尿病性玻璃体溢血患者４２例（４２眼）,取得较好效果．现报告如下。　　　　资料与方法：本组男３２例,女１０例;年龄４０～７１岁,平均５９岁;病程ｌ～３０年,平均９年。患者均因玻璃体混浊不能施行光凝,仅９眼眼底镜检查可见上方周边视网膜：Ｂ超检查均排除牵引性视网膜脱离。　　　　手术方法：术前充分散瞳,在局麻下环形剪开角膜缘后球结膜及眼筋膜．另作颞上、鼻下放射切口,用４－０丝线做４条直肌牵引线,用国产眼科冷冻机以２ｍｍ直径冻融头（－８℃）于肌止点部向后进行冷…     

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。     

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.     

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.     

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.     

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。