Ⅱ型增殖性糖尿病视网膜病变患者行玻璃体切除术的时机与术后视力分析

目的探讨Ⅱ型增殖性糖尿病视网膜病变合并严重玻璃体出血或合并血管纤维增殖引起的视网膜牵拉及牵拉性视网膜脱离情况下,进行玻璃体切除术的手术时机。方法对６４例（７８只眼）Ⅱ型增殖性糖尿病视网膜病变行玻璃体切除术的患者,按术前出血时间和视网膜病变程度各分为两组,进行术后视力恢复情况的比较。结果术后９个月,视力为０．３以上者,在术前出血时间≤６个月组为４２．１％,而在术前出血时间＞６个月组为５．３％,两组间差异有显著性（Ｐ＜０．０１）。术后１年,获得０．５以上视力者,在术前出血时间≤６个月组为３５．７％,而在术前出血时间＞６个月组为７．１％,两组间差异有显著性（Ｐ＜０．０５）;术后获０．３以上视力者,在单纯玻璃体出血合并或不合并局部牵拉性视网膜脱离组为３５．７％,而在大面积牵拉性视网膜脱离组为１６．７％,两组间差异有显著性（Ｐ＜０．０５）。结论Ⅱ型糖尿病患者发生玻璃体出血,应早期手术治疗。对出血时间长、牵拉性视网膜脱离严重的患者,也不应放弃手术治疗。     

玻璃体切除治疗增殖性糖尿病视网膜病变

目的:评价玻璃体切除术治疗增殖性糖尿病视网膜病变的效果。方法:93例(139眼)增殖性糖尿病视网膜病变病例均行玻璃体切除术,术后平均随访(16.72±8.53)mo,对视力及手术失败的原因进行回顾性分析。结果:98眼(70.50%)视力得到提高,术后视力明显好于术前(P<0.001);手术失败的主要原因是视网膜脱离和黄斑病变。结论:玻璃体切除术是治疗增殖性糖尿病视网膜病变的有效方法。     

玻璃体切割术治疗增殖性糖尿病视网膜病变

目的：观察玻璃体切割术治疗增殖性糖尿病理视网病变的疗铲及手术并发症。方法：应用睫状体平坦部玻璃体切割术治疗增殖性糖尿病视网病变患者１７例１９只眼，其中ＰＤＲＶ期１０只眼；ＰＤＲⅥ期９只眼。结果：术后视力大于０．０５者１２只眼，占６３．１％。复发性玻璃体出血５只眼，占２６．３％。结论：增殖性糖尿性视网膜病变引起的广泛玻璃体出血可以观察３个月，若视力不改善，应尽早行玻璃体例体切割术。     

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.     

玻璃体手术治疗增殖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伴有广泛纤维血管膜的严重增殖性糖尿病视网膜病变(PDR)的效果.方法 对27例28只眼伴有广泛纤维血管增殖的PDRⅥ期患者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,电凝止血,同时进行视网膜复位,眼内光凝硅油充填.结果 28只眼均顺利进行膜分离与切除,仅6只眼出现医原性视网膜裂孔.经7个月至4年半随访,手术后视网膜均复位,视力除1只眼继发新生血管性青光眼外均有不同程度的提高.结论 四切口玻璃体手术采用双手操作进行眼内剥膜和止血安全简便有效,是治疗伴有广泛纤维血管膜的严重PDR的较好方法 .     

糖尿病前部增殖性玻璃体视网膜病变

报告9例糖尿病前部增殖性玻璃体视网膜病变,描述了:其临床表现、治疗方法及手术方式,强调除行晶状体摘除外,尚需选择性采用视网膜切开、眼内电凝、条带剪切等措施。并对此病的分类、病因、病理及手术预后进行了详细讨论。     

增殖性糖尿病视网膜病变玻璃体视网膜手术后玻璃体出血的临床观察

目的：探讨增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR)玻璃体视网膜手术严重玻璃体出血的原因，并发症及处理方法。方法：对我院1997年1月至2001年3月住院行玻璃体视网膜手术治疗PDR的182例（198只眼）患者中术后发生严重玻璃体出血的16例（17只眼）患者进行回顾性分析。结果：术后玻璃体出血中52.9%出现于术后第一天，出血原因包括纤维血管膜残端出血，视网膜新生血管膜渗血，视网膜切开，视网膜裂孔，前玻璃体纤维血管增殖等；出血并发症包括继发性青光眼，增殖膜形成等。结论：PDR玻璃体切割术后玻璃体出血为术后常见的并发症；对于出血量大、难于吸收及出现并发症的病例，积极治疗可改善视力预力预后。     

糖尿病视网膜病变玻璃体切除术中晶状体的处理

玻璃体手术是治疗增生性糖尿病视网膜病变（PDR）的有效手段。多数年龄在50岁以上的糖尿病患者会发生晶状体混浊或晶状体核硬化，晶状体混浊不仅直接影响患者视力，且对术中纤维血管膜剥离、周边玻璃体切除以及周边部视网膜光凝等均会造成一定的困难。因此PDR患者在接受玻璃体手术时面临的一个常见问题就是如何处理晶状体。是在玻璃体切除的同时切除晶状体还是在玻璃体切除术后待白内障成熟时再行第二次手术呢？为此，我们组织北京同仁医院眼科中心眼底病亚科的四位医师谈谈他们的主张及理由。     

27G玻璃体切除原位切膜法治疗晚期增殖性糖尿病视网膜病变

目的：探讨27G玻璃体切除原位切膜法治疗晚期增殖性糖尿病视网膜病变(PDR)的临床疗效。

方法：收集2017-01/08晚期PDR 10例15眼临床病例,行27G微创玻璃体切除术,采用切割头原位切膜法切除增殖膜,观察术中医源性视网膜裂孔发生率、硅油填充率、术前术后最佳矫正视力、眼压等指标。

结果：患者4眼(27%,4/15)术中发生医源性视网膜裂孔; 6眼(40%,6/15)硅油填充; 术后3mo时仅2眼视力不提高,13眼术后视力提高,最好视力0.6,术前最佳矫正视力分别与术后7d,1、3mo最佳矫正视力比较,差异均有统计学意义(P<0.05); 术前平均眼压16.95±6.87mmHg,术后3mo平均眼压15.27±4.57mmHg,两者比较差异无统计学意义(P>0.05)。

结论：27G玻璃体切除原位切膜法在晚期PDR术中处理视网膜前增殖膜时优势明显,疗效确切,可为晚期复杂PDR的优选术式。     

增殖性糖尿病玻璃体视网膜病变玻璃体切割术后持续性玻璃体出血

目的：探讨增殖性糖尿病玻璃体视网膜病变玻璃体切割术后持续性出血的发生率及处理方法。方法：回顾性分析1998年1月至2000年12月共42例(53眼)增殖性糖尿病玻璃体视网膜病变玻璃体切割术后患者的临床资料。根据出血量分别给予局部糖皮质激素、降低眼内压药物、前房冲洗或玻璃体腔灌洗。结果：增殖性糖尿病玻璃体视网膜病变玻璃体视网膜病变玻璃体切割术后持续性出血共22眼，发生率52．38％收，自发清除率86．3％。2眼经前房冲洗吸收，1眼经玻璃体腔灌洗吸收。结论：持续性出血是增殖性糖尿病玻璃体视网膜病变玻璃体切割术后早期的常见并发症之一。     

Timing of vitrectomy for active proliferative diabetic retinopathy

Eyes with active proliferative diabetic retinopathy with dense sub-hyaloid hemorrhage and significant visual loss represent an appropriate indication for prompt vitrectomy. Twenty-six such eyes in 22 patients were operated. The results are compared to 49 diabetic eyes undergoing vitrectomy for other complications of diabetic retinopathy. The results demonstrated both an improved anatomic success rate (85% compared to 73%) and a higher rate of reading visual function (54% compared to 18%) in the early vitrectomy group, substantiating the study hypothesis.     

Results of vitrectomy for proliferative diabetic retinopathy

The authors treated 1007 eyes with vitrectomy for complications of proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 353 eyes (35%); traction retinal detachment, 360 eyes (36%); combined traction-rhegmatogenous retinal detachment, 172 eyes (17%); and other progressive fibrovascular proliferation 122 eyes (12%). During the study period, the frequency of vitreous hemorrhage as an indication for surgery decreased from 42 to 25%, and other progressive fibrovascular proliferation increased from 5 to 22%. The frequency of traction and traction/rhegmatogenous retinal detachments did not change. The results of surgery varied according to the indication. Seventy-nine percent of eyes with vitreous hemorrhage obtained final vision of 5/200 or better. Similar results were obtained in 64% of eyes with traction detachment, 56% of eyes with rhegmatogenous detachment, and 81% of eyes with progressive fibrovascular proliferation. The percentage of eyes achieving final vision of 20/100 or better are as follows: vitreous hemorrhage, 48%; traction detachment, 27%; rhegmatogenous detachment, 24%; and progressive fibrovascular proliferation, 46%. The success rate improved in each anatomic category during the last 3 years of the study.     

Trimanual vitrectomy for severe proliferative diabetic retinopathy

Purpose

To describe and evaluate a novel technique of pars plana vitrectomy (PPV) under chandelier illumination which is aided with the vital dyes and perfluorocarbon liquids for the management of the complex diabetic vitrectomy cases.

Methods

We conducted a prospective interventional comparative study on 40 eyes of 36 patients with advanced diabetic eye disease requiring PPV. The study was conducted in a single tertiary referral center. Eyes were divided on 1:1 basis by stratified randomization into two groups. Group 1 had trimanual vitrectomy done assisted with chandelier illumination, perfluorocarbon liquid (PFCL) and vital dyes. Group 2 had the conventional bimanual vitrectomy done assisted with chandelier illumination only. All patients were followed up for a minimum of 6 months after the surgery.

Results

Forty eyes of 36 patients with the mean age of 51.42 years (range 28–69) were evaluated. The anatomical success at 6 months could be achieved in all the eyes in both groups. The complete removal of the pre-retinal proliferations could be accomplished in all the eyes in the trimanual PPV group, and only in 85% of the eyes in the bimanual PPV group. Operative time was significantly shorter in the trimanual PPV group (p?<?0.001). More eyes in the trimanual PPV group (55.0%) could achieve better vision (>?6/60) 6 months after the operation compared to the bimanual PPV group (50.0%), but this difference was not statistically significant.

Conclusion

Trimanual PPV is a novel, safe and effective technique that can improve the results of the complex diabetic PPV.

     

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）     

康柏西普预处理联合玻璃体切割术治疗增生型糖尿病视网膜病变

目的 探讨抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物康柏西普对增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者玻璃体切割术(pars plana vitrectomy,PPV)术中和术后的影响.方法 将2016年1月至12月于我科确诊PDR伴有玻璃体出血(vitreous hemorrhage,VH)和(或)牵拉性视网膜脱离(tractional retinal detach-ment,TRD)的123例149眼患者纳入研究,其中康柏西普组64例78眼,对照组59例71眼.康柏西普组于PPV术前3d玻璃体内注射抗VEGF药物0.50 mg(0.05 mL),对照组无处理.无明显并发症后2组行标准23G微创巩膜三通道玻璃体切割术,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1个月视力及黄斑厚度进行对比,观察术后并发症情况.结果 两组患者年龄、性别、糖化血红蛋白、糖尿病病程,VH≥Ⅲ级眼数(56/78、45/71),术前TRD比较均无明显差异.康柏西普预处理可明显降低PPV术中出血(43/78、49/71)、医源性视网膜裂孔的概率(11/78、21/71),减少眼内电凝使用(57/78、62/71)及硅油填充(43/78、51/71),进而缩短手术时间(58.63±21.66)s、(72.69±22.48)s,且其可明显改善术后视力(0.23±0.15,0.16±0.11)及黄斑水肿厚度(260.95±27.44) μm、(330.81±36.62) μm,同时降低二次积血发生率(3/78、10/71).结论 康柏西普预处理联合PPV是治疗PDR患者一项积极有效的治疗方案.     

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.     

Pathologic study following vitrectomy for proliferative diabetic retinopathy

This article details the pathologic findings in eyes removed postmortem from a diabetic man with proliferative retinopathy, vitreous hemorrhage, and tractional retinal detachment. Several years before death, to control hemorrhage from extraretinal vasoproliferative lesions, one eye only was treated with argon laser panretinal photocoagulation. Eight months before death the treated eye also was operated for tractional retinal detachment with current vitrectomy methods: membranotomy, partial peeling, and segmentation of preretinal membranes. Despite their atropic clinical appearance, the extraretinal lesions on pathologic study were "active." In the operated and nonoperated eyes the vascular and nonvascular proliferative lesions were of equal severity. The sclerotomy wounds were complicated by intraocular granulation tissue, focal granulomatous inflammation related to suture fragments, and intraocular hemorrhage.