不同晶状体状态对增殖性糖尿病性视网膜病变疗效的影响

目的 探讨不同晶状体状态对增殖性糖尿病视网膜病变手术疗效的影响.方法 对30例(30只眼)行晶状体、玻璃体联合手术与38例(56只眼)行单纯玻璃体切除治疗增殖性糖尿病视网膜病变患者的临床资料进行对比分析.结果 随访6～21月,两组患者术后视力均较术前不同程度地提高,但差异无显著性.有晶状体眼组视网膜一次复位率87.50%(14/16),无和(或)假晶状体眼组视网膜一次复位率92.30%(12/13).术中并发症两组发生率接近,无统计学意义.术后并发症:有晶状体眼组2只眼(0.04%)而无和(或)假晶状体眼组4只眼(0.11%)发生角膜水肿.无和(或)假晶状体眼组前房渗出6只眼,虹膜后粘连2只眼,虹膜新生血管5只眼,而有晶状体眼组无一例发生.有晶状体眼组再次手术7只眼(13.72%).无和(或)假晶状体眼组再次手术3只眼(8.57%).结论 联合手术治疗增殖性糖尿病视网膜病变安全有效,可早期恢复患者的视力,提高视网膜复位率.但术后前房炎症反应、虹膜后粘连、虹膜新生血管及眼压升高等并发症较高,需严格掌握手术适应证.

Influence of lens status upon anatomic and visual outcomes of proliferative diabetic retinopathy

Objective To determine the effect of lens status upon the anatomic and visual results in pri-mary vitrectomy of proliferative diabetic retinopathy.Methods The clinical data,visual acuity,retinal reatach-merit rate and complications of 30 patients (30 eyes)who underwent combined vitrectomy and 38 patients(56 eyes)who underwent vitrectomy alone were retrospectively analyzed.Results Final visual acuity were all im-proved in the two groups but there was no significant difference between them.Retina of 14 eyes(87.50%)reat-tachment in phakic group and 12 eyes (92.30%)reattachment in aphakic/psendophakic group.Intraoperative complications were similar in the two groups.Postoperative complication such as corneal edema was higher for aphakic/pseudophakic group than phakic group.In aphakic/pseudophakic group,6 eyes developed anterior chamber fibrin formation, 2 eyes developed posterior synechiae and rubeosis iridis developed in 5 eyes, while there was no eye developed such complications in phakic group.The vitreoretinal reoperation rate was signifi-cantly higher (13.72%)for phakic group than for aphakic/pseudophakic group (8.57%).Conclusions Com-bined phacomulsification and lens implantation with vitrectomy is safe and effective in treating patients with proliferative diabetic retinopathy and help to earlier visual rehabilitation.But it may increase postoperative com-plications such as anterior chamber fibrin formation, posterior synechiae and rubeosis iridis.