无眼内填充的玻璃体视网膜手术治疗糖尿病视网膜病变牵引性视网膜脱离疗效观察

目的观察无硅油或气体等眼内填充的玻璃体视网膜手术治疗增生型糖尿病视网膜病变牵拉性视网膜脱离(DTRD)的长期疗效。方法回顾分析未行硅油或气体填充的玻璃体视网膜手术治疗不合并手术前或手术中医源性视网膜裂孔的DTRD患者104例112只眼的临床资料。患者中，合并虹膜新生血管（INV）者6只眼；新生血管性青光眼（NVG）者1只眼；合并黄斑区视网膜脱离者50只眼，未合并黄斑区视网膜脱离者62只眼。采用标准三切口经睫状体平坦部玻璃体切割手术，手术后均未使用硅油或惰性气体、空气填充，只保留手术中灌注液。15只眼手术中联合行白内障摘除和人工晶状体植入。手术后随访12～65个月，平均随访时间29个月。结果手术后2个月以内视网膜下液完全吸收。随访期末，107只眼视网膜1次手术复位，占95.54%。79只眼最佳矫正视力提高，占70.53%，14 只眼视力保持不变，占12.50%，19眼视力下降，占16.97%。合并黄斑区视网膜脱离眼，手术后33只眼最佳矫正视力提高，占6600%，未合并黄斑区视网膜脱离眼，手术后46只眼视力提高，占74.19%。二者比较，差异无统计学意义(χ2=0.89, P=0.34)。7只眼存在INV，占6.25%，其中5只眼为手术后新发，未出现新增NVG患者。多因素logistic回归分析显示，手术前合并INV是手术后INV的危险因子（OR＝10.15），手术前后最佳矫正视力是保护性因子（OR分别为0.09、0.06）。未行白内障手术眼中，未发现明显晶状体混浊加重。结论不用硅油或气体填充的玻璃体视网膜手术治疗未合并视网膜裂孔的DTRD即可获得较好的长期治疗效果。

Preliminary access of efficacy of vitreoretinal surgeries without endotamponade for diabetic tractional retinal detachment

Objective To evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with diabetic tractional retinal detachment (DTRD).Methods The clinical interventional case series study included 104 patients (112 eyes) with DTRD,who were consecutively treated by pars plana vitrectomy without use of intraocular silicone oil or gas.Among the eyes,there were 6 eyes with iris neovascularization (INV),1 eye with neovascular glaucoma (NVG) and 50 eyes with macular retinal detachment.There were no pre-existing retinal holes or breaks prior to surgery nor any iatrogenie retinal breaks developed during vitrectomy.Cataract removal combined with intraoeular lens implant surgeries were performed on 15 eyes.Follow-up duration varied from 12 to 65 months (mean: 29 months).Results Subretinal fluid was completely absorbed within 2 months after surgery.In 107 eyes (95.54%),the retina reattached after surgery and remained attached till the end of follow-up period.Best corrected visual acuity (BCVA) improved in 79 eyes (70.53%),remained unchanged in 14 eyes (12.500%) and got worse in 19 eyes (16.79%).The BCVA improving rate was lower in the macular detached group (33 eyes/50 eyes,66.00% Vs 46 eyes/62 eyes,74.19%,χ2=0.89,P=0.344).No obviously aggravated opacity of lens was observed after vitreoretinal surgeries in the eyes without cataract surgeries.Seven (6.25%) eyes showed INV (5 new onset eyes),and none of them developed into NVG.In multivariate logistic regression,factors associated with postoperative rubeosis iridis were pre-existing rubeosis iridis I-adjusted odds ratio (OR)= 10.2],low preoperative BCVA (OR= 11.1) and low postoperative BCVA (OR = 16.7).Conclusions Vitreoretinal surgery for DTRD may not necessarily be combined with silicone oil or gas tamponade if there are no preoperative or intraoperative retinal breaks,and only using irrigation fluid could access a good long-term prognosis result.