27G玻璃体切除原位切膜法治疗晚期增殖性糖尿病视网膜病变

目的：探讨27G玻璃体切除原位切膜法治疗晚期增殖性糖尿病视网膜病变(PDR)的临床疗效。

方法：收集2017-01/08晚期PDR 10例15眼临床病例，行27G微创玻璃体切除术，采用切割头原位切膜法切除增殖膜，观察术中医源性视网膜裂孔发生率、硅油填充率、术前术后最佳矫正视力、眼压等指标。

结果：患者4眼(27%，4/15)术中发生医源性视网膜裂孔； 6眼(40%，6/15)硅油填充； 术后3mo时仅2眼视力不提高，13眼术后视力提高，最好视力0.6，术前最佳矫正视力分别与术后7d，1、3mo最佳矫正视力比较，差异均有统计学意义(P<0.05)； 术前平均眼压16.95±6.87mmHg，术后3mo平均眼压15.27±4.57mmHg，两者比较差异无统计学意义(P>0.05)。

结论：27G玻璃体切除原位切膜法在晚期PDR术中处理视网膜前增殖膜时优势明显，疗效确切，可为晚期复杂PDR的优选术式。

27G vitrectomy with proliferative membrane cutting in situ for late PDR

AIM:To discuss the clinical efficacy of 27-gauge(27G)vitrectomy with proliferative membrane cutting in situ for late proliferative diabetic retinopathy(PDR).

METHODS: Collecting 10 cases(15 eyes)with late PDR from January 2017 to August 2017 which underwent 27G microincision vitrectomy with cutting proliferative membrane in situ, we observed the rate of intraoperative iatrogenic retinal hole(IRH), the rate of silicone oil tamponade, the best corrected visual acuity(BCVA)and intraocular pressure(IOP)before and after operation.

RESULTS: IRH occurred in 4 eyes(27%, 4/15); Silicone oil was tamponaded in 6 eyes(40%, 6/15); BCVA was improved in 13 eyes and only 2 eyes unchanged 3mo after operation. The best visual acuity(VA)was 0.6. There was significant difference on BCVA between preoperative and postoperative 7d(P<0.05). The same was found between preoperative and postoperative 1mo, even 3mo(P<0.05). The average preoperative IOP was 16.95±6.87mmHg and postoperative 3mo was 15.27±4.57mmHg. There was no significant difference between them(P>0.05).

CONCLUSION: The 27G vitrectomy with cutting proliferative membrane in situ method is markedly superior in the treatment of late PDR, and the curative effect is specific. It can be given preference to late PDR.