经睫状体扁平部玻璃体切割手术治疗糖尿病视网膜病变患者玻璃体视盘牵拉的临床观察

目的探讨经睫状体扁平部玻璃体切割手术（PPV）治疗糖尿病视网膜病变患者玻璃体视盘牵拉（VPT）的手术方法和临床疗效。方法选取糖尿病视网膜病变存在VPT的患者298例382只眼，设为VPT患眼；无VPT214眼，设为对照眼。对V胛患眼实施PPV。分别于术前对V胛患眼和对照眼进行最佳矫正视力（BCVA）、裂隙灯、眼底镜、荧光素眼底血管造影（FFA）、经光学相干视网膜断层扫描（OCT）、视觉诱发电位（VEP）及视野等眼科相关检查，术后1个月、3个月时分别对VPT患眼进行复查，分析各组间BCVA、盘沿视网膜厚度、VEP（P100潜伏期、振幅）、视野改变的情况。结果VPT患眼视盘区域损伤严重，主要表现为大片增殖膜，玻璃体腔混浊，视盘隆起视杯变浅或消失等。术前VPT患眼组BCVA、P100潜伏期、盘沿视网膜厚度均高于对照眼组，P—VEP振幅低于对照组，差异具有统计学意义（t=4．51±11．25，P〈0．05或P〈0．01）。术后所有患者玻璃体腔清晰，视盘牵拉解除，视神经纤维贴附，视盘生理凹陷形态逐渐恢复，视网膜脱离者均复位，视野检查生理盲点扩大或向心性缩小情况改善．视力较术前均有2行以上的提高。术前、术后1个月、术后3个月临近两时点比较，BCVA、P100潜伏期、盘沿视网膜厚度均逐渐降低．P—VEP振幅逐渐增高，差异具有统计学意义（t=3．59～9．11，P〈O．05或P〈0．01）。结论糖尿病视网膜病变中玻璃体视盘牵拉综合征的存在具有一定的普遍性和严重性．早期PPV可有效解除玻璃体视网膜交界面的牵拉，恢复视神经的形态和功能，对患者视野、视力具有较好的改善作用，对糖尿病视网膜病变中玻璃体视盘牵拉的早期识别和处理具有一定的指导借鉴意义。

Clinical observation on treatment of vitreopapiilary traction syndrome in patients with diabetic retinopathy by pars plan vitrectomy

Objective To explore the method and clinical effect on treatment of vitreopapillary traction syndrome （VPT） in patients with dia- betic retinopathy （DR） by pars plan vitreetomy （PPV）. Methods 298 patients with DR were included and divided into two groups. VPT group has 382 eyes with VPT. Control group has 214 eyes without VPT. Eyes with VPT were given PPV. Before operation, best corrected visual acuity （BCVA）, slit lamp, ophthalmoscopy, fundus fluorescein angiography （FFA）, the optical coherence retinal tomography （OCT）, visual evoked potential （VEP） and visual field in two groups were tested. 1 month and 3 months after operation, VPT group were reviewed. BCVA, retinal disc thickness, VEP （P100 la- tency, amplitude）, vision changes were analyzed. Results Optic disc area of eyes with VPT damaged seriously, and mainly showing large prolifera- tive membrane, vitreous opacity, disc swelling cup shallow or disappeared. Preoperative BCVA, P100 latency, retinal disc thickness in VPT group were all higher than those in control group, and P-VEP amplitude was lower than control group （t=4.51~11.25 ,P〈0.05 or P〈0.01）. After operation, all patients＂ vitreous cavity were clear, optic disc traction were disappeared, optic nerve fiber were attached, physiological depression forms gradually re- stored, retinal detachment were reattached, perimetry physiological blind spot enlargement or concentric contraction condition improved, visual acuity were improved more than 2 lines. In time point before operation, 1 month and 3 months after the operation, BCVA, P100 latency, retinal disc thick- ness gradually decreased, P-VEP amplitude gradually increased （t=3.59-9.11, P〈0.05 or P〈0.01）. Conclusion There is some universality and severity of VPT in DR, and early PPV can effectively relieve the vitreoretinal interface traction, recover morphology and function of optic nerve, and has good effect on improving patients＇visual field and visual acuity, so it has some reference and guide meaning to VPT＇s early recognition and treat- ment in DR.