氟尿嘧啶联合低分子肝素防治增殖性玻璃体视网膜病变的临床观察

目的评价氟尿嘧啶联合低分子肝素在预防玻璃体切割术后增殖性玻璃体视网膜病变发生过程中的安全性和有效性。方法本研究随机选择本科2003．4～2003．11间需行玻璃体手术治疗的视网膜脱离患者50例50眼，病例选用标准为具有玻璃体术后视网膜脱离复发的高危因素的患者，分成治疗组与对照组，治疗组灌注液中加入低分子肝素和氟尿嘧啶，药物灌注时间控制在35～45分钟之间，随访3个月，对两组结果进行对比分析结果随访3个门后，治疗组与对照组术后增殖性玻璃体视网膜病变的发生率分别为8％(2／25)和36%(9/25)，有显著性差异(P=0．041),治疗组术后因PVR造成的视网膜脱离复发率为4％(1／25)，对照组为16%(4／25)，治疗组1例和对照组4例患者成功的进行了视网膜的再次复位手术。没有发现有明显的与药物有关的眼部并发症。结论虽然术后3个月时两组视网膜脱离的复发率差异没有统计学意义，但治疗组术后增殖性玻璃体视网膜病变的发生率较对照组有意义的减少。本试验显示了手术联合氟尿嘧啶与低分子肝素可以预防术后PVR的发生。

The effects of 5 - fluorouracil with low molecular weight Heparin on the prevention from proliferative vitreoretinopathy

Objective To assess the safety and efficacy of adjuvant combination therapy using 5-fluorouracil(5-FU)and low molecular weight heparin(LMWH)for prevention of proliferative vitreoretinopathy(PVR)after vitrectomy and retinal reattachment surgery.Methods Fifty patients receive either 5-FU and LMWH therapy or placebo.Patients were selected from all patients undergoing primary vitrectomy for rhegmatogenous retinal detachment.Results of standard surgery with 5-FU and LMWH therapy or placebo were compared at the 3-month follow-up.Main Outcome assessed were development of postoperative PVR,retinal reattachment at 3 months after surgery,single operation reattachment rate,number of reoperations,and best-corrected visual acuity.Results There were 25 patients in the 5-FU and LMWH therapy group and 25 in the placebo group.The incidence of postoperative proliferative membrane was significantly lower(P=0.041)in the 5-FU and LMWH therapy compared with the placebo group.In 36%(9/25)of the placebo group and in 8%(2/87)of the 5-FU and LMWH group,postoperative PVR developed.In the 5-FU and LMWH group,the rate of patients recurrent retinal detachment was 4%(1/25)and 16%(4/25).The difference in visual acuity was not statistically was significantly lower(P=0.041)in the 5-FU and LMWH therapy compared with the placebo group.In 36%(9/25)of the placebo group and in 8%(2/87)of the 5-FU and LMWH group,postoperative PVR developed.In the 5-FU and LMWH group,the rate of patients recurrent retinal detachment was 4%(1/25)and 16%(4/25).The difference in visual acuity was not statistically different in the two treatment groups,There were no differences in complication rates between the two groups.Conclusions There is a significant reduction in the incidence of postoperative PVR in patients receiving the 5-FU and LMWH therapy.This trial shows combination use of 5-FU and LMWH can effective prevent the postoperative recurrent PVR.