增殖性糖尿病视网膜病变联合手术治疗的应用研究

目的探讨玻璃体切除术联合白内障超声乳化摘除人工晶体植入术治疗增殖性糖尿病视网膜病变（PDR）合并白内障的临床效果及并发症。方法分析合并白内障的PDR患者54例（58眼）行白内障超声乳化摘除联合玻璃体切除囊袋内植入后房型人工晶体的临床资料,观察术后视力改善及并发症情况。结果术后随访3个月~2.5年。手术后58眼中最佳矫正视力提高两行以上者46眼,占79.31%;视力无明显变化7眼（12.07%）,视力下降5眼（8.62%）。术后发生虹膜新生血管（INV）1眼,占1.72%;术后主要并发症包括角膜轻度水肿、暂时性眼压升高、前房渗出、虹膜后黏连、玻璃体积血、视网膜脱离、新生血管性青光眼、后发性白内障等;虹膜后黏连在有硅油或惰性气体填充的眼内发生率较高。结论玻璃体切除联合超声乳化白内障摘除人工晶体植入手术是治疗PDR提高视力的有效手段,糖尿病黄斑病变是影响术后视力提高的主要因素。

Combined phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy

Objective To observe the effectiveness and postoperative complications of pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation in patients with cataract and proliferative diabetic retinopathy. Methods The clini- cal data of fifty -four cases （58 eyes） with cataract and proliferative diabetic retinopathy who were received combined surgery in our hos- pital were retrospectively analyzed. Postoperative visual acuity and postoperative complications were analyzed. Results The postoperative follow - up interval ranged from three months to two and half years. Postoperative visual acuity improved by two lines or more in 46 eyes （79.31%）. Vision remained unchanged in 7 eyes （12.07%） and decreased in 5 eyes （8.62%）. Iris neovascuiarization （INV） ap- peared in one eye （ 1.72% ） after surgery. Postoperative complications consisted of a mild corneal edema, transient intraocular pressure increase, anterior chamber fibrin exudation, posterior synechiae of the iris, vitreous hemorrhage, retinal detachment, neovascular glaucoma, posterior capsule opacification. The incidence of posterior synechiae of the iris was higher in the eyes with silicone oil or long - acting gas tamponade. Conclusion Pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation is an effective surgi- cal method for patients with cataract and proliferative diabetic retinopathy to improve visual acuity. Diabetic macular abnormalities are the main reason which affected the improvement of visual acuity.