联合手术治疗糖尿病视网膜病变合并白内障的临床观察

目的:探讨玻璃体切除联合白内障超声乳化人工晶状体植入术在合并白内障的增生性玻璃体视网膜病变(proliferative diabetic retinopathy,PDR)中的临床治疗效果。方法:回顾性分析34例39眼合并白内障的PDR患者行睫状体平坦部玻璃体切除联合白内障超声乳化术,根据眼底情况是否植入人工晶状体的临床资料,观察术后视力恢复情况,视网膜病变情况以及手术并发症。结果:随访3mo~2a,视力<0.1者12眼,0.1~0.2者14眼,0.2~0.5者9眼,>0.5者4眼,与术前视力相比,差异有显著性。术后2~3mo眼底荧光造影检查,27眼眼底激光斑清晰,新生血管萎缩,无明显荧光渗漏,12眼有不同程度的微血管瘤以及荧光渗漏,16眼存在不同程度的黄斑水肿。手术并发症包括角膜水肿、医源性视网膜裂孔、高眼压、后囊膜混浊、玻璃体再出血。结论:玻璃体切除联合白内障超声乳化人工晶状体植入术是治疗合并白内障的增生性糖尿病视网膜病变安全有效的治疗手段。无严重并发症发生。

Combined surgery for the treatment of cataract and proliferative diabetic retinopathy

AIM:To investigate the clinical efficacy of the pars plana vitrectomy combined with phacoemulsification in the treatment of cataract and proliferative diabetic retinopathy(PDR). METHODS: A retrospective review clinical data consisted of 39 eyes of 34 patients with cataract and PDR, 39 eyes were treated with the techniques of phacoemulsification and pars plana vitrectomy, intraocular lens was inserted in 32 eyes. Triamcinolone acetonide was injected in 11 eyes. RESULTS: Of 39 eyes after follow-up of 3 months to 2 years, vision <0.1 was in 12 eyes ,0.1- 0.2 in 14 eyes, 0.2- 0.5 in 9 eyes,>0.5 in 4 eyes. Postoperatively FFA indicated that fluorescein leakage disappeared and new vascularization withered in 27 eyes, there were macular edema in 16 eyes. CONCLUSION: The pars plana vitrectomy combined with phacoemulsification is effective and safe in treatment of PDR and cataract, without serious complications.