Pars plana vitrectomy in eyes containing a treated posterior uveal melanoma

PURPOSE: To determine the safety of pars plana vitrectomy in eyes containing a treated posterior uveal melanoma. DESIGN: Interventional case series. METHODS: Retrospective case series of patients with posterior uveal melanoma who underwent pars plana vitrectomy. Complications, vitreous cytology, local tumor control, and metastasis were assessed. RESULTS: Nine patients met study criteria. Tumors were treated with (125)I plaque radiotherapy (seven patients) or transpupillary thermotherapy (two patients). Vitrectomy was performed for vitreous hemorrhage (five patients), macular pucker (two patients), macular hole (one patient), and rhegmatogenous retinal detachment (one patient). Vitrectomy was performed at a mean of 24.7 months (range, 7-47 months) after melanoma treatment. Dispersion of tumor cells at vitrectomy was not observed in any patients. Melanoma cells were detected in the vitreous aspirate in one of seven cases examined cytologically. This patient had intratumoral and vitreous hemorrhage before plaque radiotherapy, underwent combined vitrectomy/cataract extraction, and developed intraocular tumor dissemination 56 months after vitrectomy. No other patients developed intraocular tumor dissemination. At mean follow-up of 24 months (range, 3-63 months) after vitrectomy, none of the nine patients developed systemic metastasis. CONCLUSIONS: Pars plana vitrectomy rarely may lead to intraocular tumor dissemination, although the risk of this complication is probably low if the tumor has been treated and has responded to therapy before vitrectomy. Vitrectomy should be approached with caution if a vitreous hemorrhage is present, especially if the hemorrhage occurred before tumor treatment, as this may seed tumor cells into the vitreous cavity.     

玻璃体手术治疗眼内异物分析

目的：探讨眼内异物的玻璃体手术取出方法的优缺点。方法：35例（35只眼）眼内异物患者，伴严重眼内炎3只眼，外伤性白内障22只眼，玻璃体出血机化16只眼。经眼底和超声检查伴视网膜脱离12只眼。玻璃体部分后脱离5只眼。异物为铁、铜、不锈钢、玻璃、石块、矿砂等，大小自0．5mm-25mm，大部分伴屈光间质混浊，异物停留在玻璃体、视网膜或球壁，经玻璃体手术取出，再结合切除混浊晶状体、环扎、气液交换、注硅油等。结果：异物一次取出成功34只眼，占97．1％。手术后并发症主要有出血、高眼压、白内障和视网膜脱离等。术后视力下降6只眼，不变10只眼，好转19只眼。结论：玻璃体手术取异物能同时解除屈光间质混浊、眼内炎，治疗视网膜脱离，是一种较好的手术。但也有不少并发症，手术复杂，需仔细检查、设计周密，术中配合良好，才能达到取异物成功、并发症少的最理想后果。     

Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

玻璃体手术治疗葡萄膜炎合并症

目的 探讨玻璃体手术对葡萄膜炎合并症的治疗价值。方法 14例（14只眼）严重急、慢性葡萄膜炎患者,其中合并重度玻璃体混浊6例（6只眼）,白内障5例（5只眼）,孔源性视网膜脱离5例（5只眼）。14例患者均行经睫状体平坦部的玻璃体切除术,部分患者根据病情联合中行经睫状体平坦部的晶状体切除、巩膜冷凝、巩膜环扎、硅胶填压、眼内光凝、气液交换或眼内硅油填充术。术后患者随访18－45个月。结果 12只眼术后视力明显提高,2只眼术前视力为光感,术后视力无改变;5例视网膜脱离患者术后视网膜完全复位;14例患者术后全身用药减少,炎症得到控制。结论 玻璃体手术是治疗严重葡萄膜炎合并症的有效方法,可以明显提高患者视力,减少全身用药量。     

Results of cataract surgery in previously vitrectomized eyes

PURPOSE: To evaluate the difficulties and results of manual extracapsular cataract extraction (ECCE) and phacoemulsification cataract surgery performed in previously vitrectomized eyes. SETTING: Pécs University of Sciences, Faculty of Medicine, Department of Ophthalmology, Pécs, Hungary. METHODS: This retrospective case-control study comprised a series of 84 cataract extractions with or without intraocular lens implantation. Forty-three patients had manual ECCE and 41, phacoemulsification. The intraoperative and postoperative complications and visual outcomes in the 2 groups were analyzed and compared. RESULTS: Cataract extractions were performed a mean of 15.8 months (range 1 to 86 months) after the pars plana vitrectomy. The indications for vitrectomy were diabetic retinopathy, retinal detachment, proliferative vitreoretinopathy, giant retinal tear, macular hole, eye trauma, vitreous hemorrhage after central retinal vein occlusion, and uveitis. Primary posterior capsule fibrosis was the most common intraoperative complication, occurring in 24% of eyes. Posterior capsule rupture occurred in 5 eyes in the ECCE group and 3 in the phacoemulsification group. Zonulysis occurred in 2 and 1 eyes, respectively. A dropped nucleus occurred in 3 cases in the phacoemulsification group. Posterior capsule opacification and secondary glaucoma were the most common postoperative complications, occurring in 5 and 3 cases in the ECCE group, respectively, and in 3 and 4 cases in the phacoemulsification group. Visual acuity 6 weeks postoperatively improved or remained within 2 Snellen lines in 95% of eyes, which is comparable to data in the recent literature. CONCLUSIONS: Phacoemulsification gave better results than manual ECCE in previously vitrectomized eyes. Underlying retinal disease limited the final visual acuity.     

Lens-sparing vitrectomy in predominantly posterior persistent fetal vasculature syndrome in eyes with nonaxial lens opacification

PURPOSE: To determine indications and document anatomic and functional outcomes for lens-sparing vitreous surgery in eyes with predominantly posterior persistent fetal vasculature syndrome and nonaxial lens opacification. STUDY DESIGN: Retrospective interventional clinical series. METHODS: The authors performed lens-sparing vitreous surgery on nine eyes of infants with predominantly posterior persistent fetal vasculature syndrome and nonaxial lens opacification without removing the crystalline lens. Indications for surgery included primarily posterior complications of persistent fetal vasculature syndrome (localized tractional retinal detachment), a centrally clear lenticular axis, and frequently strabismus. RESULTS: Postoperatively, seven of nine eyes showed no evidence of increasing lens opacification with a median follow-up period of 16.8 months (range, 5-29 months). The first eye operated on developed a rapidly progressive cataract and prompted modification of the surgical technique. One additional eye also required cataract extraction for progressive lenticular opacification 23 months after surgery. No eyes developed postoperative retinal detachment, and all eyes maintained vision at the final follow-up. Of the seven eyes with strabismus, five improved after vitreous surgery alone, and two required additional strabismus surgery. CONCLUSIONS: This series shows that, in selected cases of persistent fetal vasculature syndrome that are predominantly posterior in nature with nonaxial lens opacification, lens-sparing vitrectomy can be of benefit.     

玻璃体腔药物注射联合玻璃体手术治疗脉络膜脱离型视网膜脱离的探讨

目的 探讨术前玻璃体腔注射曲安奈德及healon联合玻璃体手术治疗脉络膜脱离型视网膜脱离的疗效及安全性.方法 选择未经有效治疗的脉络膜脱离型视网膜脱离患者11例(1 1只眼),于手术前经睫状体平坦部向玻璃体腔内注入曲安奈德混悬液和healon,注药后观察眼压葡萄膜炎反应及脉络膜脱离消失情况,并于5日之内行玻璃体手术.结果 注药后11只眼眼压均恢复良好,葡萄膜炎反应症状均不同程度减轻,10只眼脉络膜脱离眼于注药后5日内消失,所有病例均行玻璃体手术,术后11只眼均视力有不同程度提高,10只眼视网膜复位良好.结论 术前玻璃体腔注射曲安奈德和healon联合玻璃体手术是一种安全有效地治疗脉络膜脱离型视网膜脱离的方法.     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

复杂眼外伤的玻璃体切除联合手术治疗

目的:探讨玻璃体切除联合手术治疗复杂眼外伤的疗效。方法:玻璃体切除联合白内障摘除、人工晶状体Ⅱ期植入、眼内异物摘出、视网膜脱离复位治疗复杂眼外伤26例26眼。结果:术后视力较术前提高者19眼,视力不变者6眼,视力下降者1眼;眼内炎2眼感染控制,眼内异物9眼均一次成功摘出,视网膜脱离成功复位者5眼,眼球萎缩1眼。结论:选择恰当的手术时机,合理的手术方案,对挽救眼球和恢复视功能起着决定性作用。     

Combined phacoemulsification,intraocular lens implantation,and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology

PURPOSE: To report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute between March 1995 and May 2000 were reviewed. RESULTS: In all, 122 eyes of 111 patients were identified. Patient ages ranged from 27 to 89 years (mean 65). Forty-three eyes had diabetic retinopathy; 11 had undergone vitrectomy previously. Macular pathology (hole, membrane, choridal neovascularization) was present in 69 eyes. The most common indications for surgery were diabetic vitreous hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification and IOL implantation were performed before vitreoretinal surgery. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. In 105 patients vision improved, in 7 there was no change, and in 10 vision decreased. Postoperative complications included opacification of the posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous hemorrhage, retinal detachment and iris capture by the IOL. CONCLUSIONS: Combined surgery is a reasonable alternative in selected patients. Techniques that may simplify surgery and reduce complications include: careful, limited, curvilinear capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting dilating drops in patients with intravitreal gas; and use of wide-field viewing systems.     

Terson综合症的玻璃体切割手术治疗

目的：报道并分析玻璃体切割手术治疗Terson综合症的临床疗效。方法：对15例Terson综合症患(21眼)行玻璃体切割手术治疗并进行追踪观察,平均随诊时间为19．1mo。结果：手术中发现15眼(71．4％)出现了不完全性的玻璃体后脱离(PVD),7眼(33．3％)有视网膜前膜形成,4眼(19．0％)发生视网膜脱离。术后所有眼的视力均得到明显的改善,其中17眼(80．9％)视力达到或超过0．5;4眼(19．0％)发生晶状体混浊。结论：玻璃体切割手术治疗Terson综合症能显提高视力,其并发症包括白内障等的发生率低。     

One hundred consecutive cases of pars plana vitrectomy with the vitreous stripper

The results of 100 consecutive cases of pars plana vitrectomy are reported. Vitrectomy was performed on accunt of complications of diabetic retinopathy (37 eyes), complicated retinal detachment (28 eyes), vitreous haemorrhage of various causes (17 eyes), vitreous haemorrhage and complications secondary to injuries (13 eyes) and secondary cataract or vitreous in the anterior chamber creating corneal dystrophy (5 eyes). With an average follow-up time of 14.2 months, vitrectomy resulted in visual improvement in 55 eyes, unchanged visual acuity in 24 eyes and reduced visual acuity in 21 eyes. The operative and postoperative complications were: secondary vitreous haemorrhage (11 eyes), retinal detachment (8 eyes), haemorrhagic glaucoma (7 eyes), retinal tears (5 eyes), lens injury (4 eyes), corneal dystrophy (2 eyes) and endophthalmitis (1 eye).     

玻璃体切除联合白内障手术治疗55例PDR疗效分析

目的:评价玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗增生性糖尿病视网膜病变(PDR)的疗效及并发症。方法:回顾性分析55例68眼伴有白内障的PDR患者行玻璃体切除联合晶状体超声乳化及人工晶状体植入术的临床资料,观察术后视力改善程度及术中、术后并发症。结果:术后随访3～24(平均8.5)mo。51眼(75%)术后视力维持或改善,17眼(25%)视力下降,其中无光感6眼(9%);术中并发症为医源性视网膜裂孔15眼(22%);术后并发症:前房炎性反应30眼(44%),玻璃体积血11眼(16%),复发性视网膜脱离3眼(4%),虹膜红变5眼(7%),新生血管性青光眼2眼(3%);31眼(46%)术后需要继续眼内光凝。结论:玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗PDR,可使大多数患者的视力改善,手术是安全的,手术成功的关键为选择合适的患者,影响术后视力的主要因素为视网膜病变程度。     

玻璃体手术治疗视网膜静脉周围炎并发症的疗效

目的 观察视网膜静脉周围炎合并玻璃体积血和(或)牵引性视网膜脱离行玻璃体切割术的疗效及并发症。 方法 回顾性分析1989～2001年行玻璃体切割术治疗合并玻璃体积血和(或)牵引性视网膜脱离的视网膜静脉周围炎患者69例的临床和随访资料。随访时间为手术后6个月～12年，平均随访时间45个月。 结果 (1)手术后视力较手术前显著提高。(2)11只眼有手术中并发症，占14.3%，其中医源性裂孔7只眼，手术中出血3只眼，晶状体损伤1只眼。(3)手术后1个月内20只眼有并发症，占260%，其中玻璃体再积血14只眼，一过性高眼压6只眼，视网膜脱离5只眼，前房出血2只眼，前房机化膜形成1只眼。(4)远期并发症主要为白内障(9只眼)及黄斑病变(6只眼)。 结论 玻璃体切割术联合眼内激光光凝、剥膜等是治疗视网膜静脉周围炎合并玻璃体积血和(或)牵引性视网膜脱离的有效手段。 (中华眼底病杂志, 2002, 18: 215-217)     

Retinal detachment in eyes with vitreous loss and an anterior chamber or a posterior chamber intraocular lens: comparison of the incidence

PURPOSE: To compare the incidence of retinal detachment within 6 months of cataract surgery complicated by vitreous loss in eyes with a posterior chamber intraocular lens (PC IOL) or an anterior chamber IOL (AC IOL). SETTING: Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel. METHODS: In this retrospective consecutive nonrandomized comparative case series, all cases of cataract surgery complicated by vitreous loss between January 1991 and March 1998 were reviewed. Included were patients who had thorough anterior vitrectomy and primary IOL implantation and at least 6 months follow-up. Exclusion criteria were congenital and traumatic cataract, previous intraocular surgery, and previous retinal detachment. Patients receiving an unsutured single-piece poly(methyl methacrylate) (PMMA) PC IOL formed the PC group, while those receiving flexible open-loop single-piece PMMA AC IOLs formed the AC group. The incidence of postoperative retinal detachment in the 2 groups was compared. RESULTS: Of the 151 eyes of 149 patients, 66 received a PC IOL and 85 received an AC IOL. Two eyes (3.0%) in the PC group and 2 (2.4%) in the AC group developed retinal detachment; the difference between groups was not statistically significant (P = 1.00, Fisher exact test). CONCLUSIONS: In eyes that have vitreous loss and thorough anterior vitrectomy, AC IOL implantation did not appear to increase the incidence of retinal detachment.     

Vitrectomy in the management of diabetic eye disease.

Vitrectomy techniques including endolaser photocoagulation allow visual rehabilitation in many eyes that are otherwise untreatable. Discerning the indications and timing for diabetic vitrectomy is increasingly important as the treatment of complications of diabetic retinopathy continues to undergo modification and redefinition. The most common indications for diabetic vitrectomy include: 1) severe nonclearing vitreous hemorrhage; 2) traction retinal detachment recently involving the macula; 3) combined traction and rhegmatogenous detachment; 4) progressive fibrovascular proliferation; and 5) rubeosis iridis and vitreous hemorrhage for eyes in which the media opacity has prevented adequate laser photocoagulation. Other less common indications in selected cases include dense premacular hemorrhage, ghost cell glaucoma, macular edema with premacular traction, cataract preventing treatment of severe, proliferative diabetic retinopathy, anterior hyaloidal fibrovascular proliferation, and fibrinoid syndrome with retinal detachment. The rationale and surgical objectives are discussed and results are summarized.     

Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification

PURPOSE: To report the rate of retinal detachment after vitrectomy for retained intravitreal lens material after phacoemulsification using specific vitrectomy techniques designed to minimize retinal detachment. DESIGN: Consecutive, interventional case series. METHODS: Retrospective chart review of 100 consecutive eyes (one surgeon) of 100 patients undergoing vitrectomy for retained lens material after phacoemulsification and followed up for 3 months or longer unless an outcome event had occurred. Vitrectomy techniques employed to minimize the frequency of retinal detachment included inducing posterior vitreous detachment with maximal vitreous removal before phacofragmentation to avoid vitreous trauma, lens fragment debulking before fragmentation, use of low energy with high aspiration during removal of retained lens material, and intraoperative indirect ophthalmoscopic evaluation of the retinal periphery with scleral indentation to diagnose and treat intraoperative retinal breaks. The main outcome measures included prevalence of coexisting retinal detachment in eyes with retained lens material, incidence of retinal detachment or retinal breaks after vitrectomy for removal of retained lens material, and final visual acuity. RESULTS: The prevalence of previtrectomy retinal detachment was 4%; the incidence of postvitrectomy retinal detachment was 4%; the final visual acuity was 20/40 or better in 53%. One patient had a retinal break recognized during vitrectomy and was treated with retinocryopexy, but postoperative retinal detachment developed from a separate break. Three others were treated during vitrectomy for retinal breaks (including two with known preexisting breaks) and did not have any retinal detachment. Poor previtrectomy visual acuity (hand motions) was a risk factor for postvitrectomy retinal detachment. CONCLUSIONS: The rate of retinal detachment reported after vitrectomy for retained lens material after phacoemulsification can be minimized to approximately the rate expected with cataract extraction complicated by vitreous loss by employing standard surgical techniques. Higher risk eyes may benefit from more frequent postvitrectomy examinations.     

玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果

目的 探讨玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果.方法 为系列病例研究.选择16例(16只眼)并发玻璃体视网膜疾病的中间葡萄膜炎患者进行玻璃体手术治疗.术后随访5～32个月,平均(14.25±7.90)个月.随访期间观察患者视力、术后并发症及中间葡萄膜炎的复发情况.结果 16例(16只眼)患者中,有4例分别患有肺结核、多发性硬化、Beheet综合征及风湿性关节炎等全身性疾病,其余12例无系统性疾病.术前所有患者均有糖皮质激素治疗史,使用时间为6～16个月,平均(9.94±2.67)个月.玻璃体视网膜并发症包括重度玻璃体混浊伴机化5只眼,牵引性视网膜脱离6只眼,孔源性视网膜脱离1只眼,玻璃体积血2只眼,黄斑前膜伴玻璃体机化2只眼,所有患眼均出现周边部视网膜新生血管.术后并发白内障3只眼,牵引性视网膜脱离1只眼.术后4例患者需长期服用糖皮质激素或联合免疫抑制剂治疗.术后视力提高或保持不变14只眼,视力下降2只眼,与术前视力比较差异有统计学意义(x2=4.923,P＜0.05).术后未见中间葡萄膜炎复发者.结论 对严重或药物控制不佳而出现玻璃体视网膜并发症的中间葡萄膜炎患者采用经平坦部的玻璃体手术治疗,可以明显改善患者视力,减少长期使用免疫抑制剂治疗的不良反应.     

慢性葡萄膜炎黄斑病变的玻璃体手术治疗

目的探讨玻璃体手术对慢性葡萄膜炎合并黄斑病变的治疗价值.方法16例（16眼）反复发作6月以上的慢性迁延性葡萄膜炎,其中合并囊样黄斑水肿6眼,黄斑前膜5眼,玻璃体黄斑牵引综合症4眼,黄斑孔性视网膜脱离1眼,采用玻璃体切除联合人工玻璃体后脱离,内界膜剥离等.术后随访12～30月.结果12眼（75.00%）术后视力明显提高,视力不变或下降4眼为囊样黄斑水肿;视网膜脱离复位;16例术后全身用药减少,炎症得到控制.结论玻璃体手术是治疗慢性葡萄膜炎黄斑病变的有效手段,可以明显提高患者视力,减少全身用药量.     

玻璃体切割联合白内障手术治疗增生性糖尿病视网膜病变

目的观察玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术及硅油填充术治疗增生性糖尿病视网膜病变的疗效。方法将63例(67眼)增生性糖尿病视网膜病变患者进行玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等,术后随访3～18个月观察治疗效果。结果单纯玻璃体视网膜手术23眼,联合晶状体超声乳化人工晶状体植入术25眼,术中注入硅油37眼。术后矫正视力不同程度改善52眼,11眼不变,4眼下降。术中眼内出血5眼;术后玻璃体积血2眼,视网膜上出血2眼,一过性高眼压14眼,继发性青光眼2眼,白内障加重或形成13眼,后发性白内障形成6眼。结论玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等治疗增生性糖尿病视网膜病变安全有效,联合手术可避免再次行白内障手术,减少视网膜脱离、白内障、继发性青光眼等并发症的发生率。