糖尿病黄斑水肿玻璃体手术治疗1a预后

目的观察玻璃体手术治疗糖尿病黄斑水肿(DME)术后1 a的疗效.方法对89例(116眼)糖尿病黄斑水肿患者行玻璃体手术,观察手术前、后患者的视力、黄斑水肿改善程度以及手术并发症的情况.随访时间为1a.结果随诊1a,术后最佳矫正视力(0.428±0.387mean±SD])与术前最佳矫正视力(0.285±0.249)比较,差异有非常显著意义(P＜0.0001);41只非增殖性糖尿病视网膜病变眼中,术后最佳矫正视力(0.450±0.410)与术前最佳矫正视力(0.291±0.201)比较,差异有显著意义(P=0.0171);75只增殖性糖尿病视网膜病变眼中,术后最佳矫正视力(0.41 6±0.376)与术前最佳矫正视力(0.282±0.272)比较,差异有非常显著意义(P＜0.0001);糖尿病视网膜病变分期对最终视力并无影响.术后,74眼黄斑水肿吸收,占63.8%.随诊中,53眼最佳矫正视力提高2行或2行以上,占45.7%;39眼视力不变,占33.6%;24眼视力下降2行或2行以上,占20.7%.术中及术后并发症包括,医源性视网膜裂孔,玻璃体积血,新生血管性青光眼,黄斑中心凹硬性渗出,黄斑萎缩及黄斑上膜.这些并发症中造成最佳矫正视力下降2行或2行以上的原因是新生血管性青光眼(4眼),黄斑萎缩(10眼),硬性渗出(9眼)及黄斑上膜(1眼).结论玻璃体手术可以有效提高糖尿病黄斑水肿患者的视力及改善黄斑水肿,但此治疗有着严重的并发症,因而应仔细认真行术前术后检查,掌握手术技巧.

Visual Outcome and Complications of Vitrectomy for Diabetic Macular Edema at One-Year Follow-up

AIM: To evaluate the surgical efficacy of vitrectomy for diabetic macular edema (DME) at one year's follow-up.METHODS: The surgical outcomes in 116 consecutive eyes of 89 patients who had vitrectomy for diabetic macular edema were retrospectively reviewed and analyzed. All the patients were followed up for one year or longer postoperatively.RESULTS: The one year postoperative mean best-corrected visual acuity (BCVA) (0.428± 0.387) was significantly better than the mean preoperative BCVA (0.285±0.249;Wilcoxon signed-rank test, P＜0.0001). In 41 eyes with nonproliferative diabetic retinopathy (NPDR), mean BCVA improved significantly from 0.291± 0.201 preoperatively to 0.45± 0.41 at one year of follow-up (Wilcoxon signed-rank test, P=0.0171). In 75 eyes with proliferative diabetic retinopathy (PDR), mean BCVA improved significantly from 0.282± 0.272 preoperatively to 0.416± 0.376at one year of follow-up (Wilcoxon signed-rank test, P＜0.0001). The stage of diabetic retinopathy did not influence final visual acuity. Macular edema resolved in 74 of 116 eyes (63.8%) after the surgery. BCVA improved by 2 or more lines in 53 eyes (45.7%), remained unchanged in 39 eyes (33.6%), and exacerbated by 2 or more lines after the surgery in 24 eyes (20.7%). The intraoperative and postoperative complications included iatrogenic retinal tears (9 eyes), vitreous hemorrhage (10 eyes), neovascular glaucoma (6 eyes), hard exudates deposition in the center of macula (18 eyes), macular atrophy (19 eyes) and epiretinal membrane (3 eyes). Among these complications,exacerbation of BCVA by 2 or more lines occurred due to neovascular glaucoma (4 eyes), macular atrophy (10 eyes), hard exudates deposition (9 eyes) and epiretinal membrane (1 eyes).CONCLUSIONS: Vitrectomy is an effective procedure for improving visual acuity and reducing macular edema in eyes with DME. However, careful preoperative examinations and adequate surgical techniques are imperative to avoid severe complications of this treatment.