玻璃体切除术联合多波长激光光凝治疗增殖型糖尿病视网膜病变

目的探讨玻璃体切除术联合多波长激光光凝治疗增殖型糖尿病视网膜病变的临床效果。方法对102例(118只眼)增殖型糖尿病视网膜病变患者行玻璃体切除术治疗,多数病例术后1周内开始行多波长激光光凝治疗,并在术后1个月内完成全视网膜光凝。术后随访为1～15个月,观察视力、眼底等。结果 118只眼中视力≥0.02的眼数由治疗前的49只眼(41.5%)增加到治疗后的86只眼(72.9%),其中,≥0.1的的眼数由治疗前的18只眼(15.3%)增加到治疗后的54只眼(45.8%)。玻璃体手术中未造成新的视网膜脱离,术前已有视网膜脱离的46只眼,术后视网膜均得到复位,其中35只眼填充硅油,22只眼已于随访期间取出硅油,视网膜脱离未复发。并发症主要有:手术后持续较浓密的玻璃体积血11只眼,其中5只眼接受了再手术;光凝期间玻璃体再出血6只眼,2只眼接受了再次手术;虹膜红变及新生血管性青光眼5只眼,眼球萎缩2只眼。结论玻璃体切除术能够有效治疗严重的增殖型糖尿病视网膜病变,通过联合应用多波长激光全视网膜光凝治疗,能显著改善手术预后,降低手术并发症的发生,提高或保留患者的视力,减少失明率。

Vitrectomy Combined with Multi-wavelength Laser Photocoagulation Treatment of Proliferative Diabetic Retinopathy

Objective To discuss the clinical effects of vitrectomy combined with multi-wavelength laser photocoagulation for the treatment of proliferative diabetic retinopathy. Methods Totally 102 patients（11 eyes） were received vitrectomy surgery.Photocoagulation by using multi-wavelength laser was implemented within a week in the most cases,and completed panretinal photocoagulation therapy within one month.Patients were followed up for 1 to 15 months to observe the visual acuity,fundus and so on. Results Among 118 eyes,the number of eyes with visual acuity≥0.02 was increased from 49（41.5%） to 86（72.9%） after treatment,of which,that with≥0.1 was increased from 18（15.3%） to 54（45.8%） after treatment.Vitrectomy surgery did not cause a new retinal detachment,there were 46 eyes of retinal detachment before surgery,all of them were to be reset after surgery,in which 35 filled with silicone oil,22 silicone oil was removed during the follow-up,no recurrence of retinal detachment was seen.Complications： 11 eyes with persistent dense vitreous hemorrhage after surgery,of which five received re -operation;during photocoagulation, 6 eyes break out vitreous rebleeding,2 eyes received re-operation;5 eyes were with red transformation and neovascular glaucoma, 2 eyes with eyeball atrophy. Conclusions Vitrectomy is effective treatment for severe proliferative diabetic retinopathy,through the combined application of multi-wavelength laser panretinal photocoagulation treatment can significantly improve prognosis and reduce the incidence of complications and improve or retain the vision and reduce the rate of blindness.