非接触全视网膜镜用于重度增生性糖尿病视网膜病变手术的效果观察

目的探讨非接触全视网膜镜下行重度增生性糖尿病视网膜病变玻璃体切割手术与传统接触式视网膜透镜相比较的安全性和优越性。方法回顾性分析2013年1月²014年8月期间的严重增生性糖尿病视网膜病变进行玻璃体切割手术的连续病例临床资料,对术前最佳矫正视力、玻璃体视网膜情况、手术时间、手术并发症、术后1月最佳矫正视力、视网膜在位率等进行分析。结果共有49例(62眼)患者进行了玻璃体切割手术治疗,手术中的处理包括玻璃体切除、增殖膜剥除、视网膜激光光凝、眼内电凝、视网膜复位、气液交换、注气/注油等操作。其中15例(19眼)手术在传统接触式视网膜透镜下进行,34例(43眼)手术是在非接触全视网膜镜下进行。平均手术时间分别为(96.3±23.5)min、(54.6±15.1)min,医源性裂孔的发生率分别为36.8%、16.3%,术后视力较术前视力提高的比例分别为68.4%、93.0%,两组相比均有统计学意义。结论由于非接触全视网膜镜提供广角的接近全部视网膜的宽广视野,图像立体感强,明显提高了手术中对增殖膜的处理、周边玻璃体视网膜的操作、气液交换的效率,减少医源性裂孔的形成;手术不需要缝合金属环和反复调整更换透镜,缩短了手术时间,具有较明显的优势。

NON -CONTACT WHOLE RETINAL SURGERY APPLY TO SEVERE PROLIFERATIVE DIA- BETIC RETINOPATHY

Objective To evaluate security and superiority of the non - contact full retinoscope downward severe proliferative diabetic retinopathy vitreous cut operation and traditional contact lens retinal. Methods By a ret- rospective analysis in January 2013 to August 2014, serious proliferative diabetic retinopathy of vitreous during con- secutive cases of clinical data, the cutting on their best corrected visual acuity, preoperative vitreous retinal situation, operation time, surgical complications, the postoperative best corrected visual acuity and retinal in January rate were analyzed. Results A total of 49 patients （62 eyes） of the vitreous was cut by surgery, including vitrectomy, mem- brane peeling, proliferation, retinal laser photocoagulation, intraocular electric coagulation, retinal reposition, ex- change of gas and liquid, gas injection/oil, etc. 15 cases （19 eyes） were engaged with the traditional contact lens retinal surgery ; 34 cases （43 eyes） surgery is in the non - contact full retinoscope under. Average operation time was （96.3 ± 23.5） min and （54.6 ± 15.1 ） rain, respectively. The incidence of iatrogenic stage were 36.8% and 16. 3%. The proportion of the visual acuity of vision after surgery was improved to 68.4% and 93.0% , respectively. The two groups have statistical significance. Conclusion Because the non - contact whole retina provides wide - angle lens close to all the retina＇ s broad field of vision, image stereo sense is strong, and significantly improve the handling of the proliferation of membrane in the operation, surrounding the operation of the vitreous retinal, gas - liquid exchange efficiency, and reduce the formation of iatrogenic hiatal. Surgery does not need to suture the metal rings, repeat adjustment replacement lens and shorten the operation time, which has apparent advantage.