玻璃体切割治疗弥漫性糖尿病黄斑水肿疗效观察

目的:研究玻璃体切割治疗弥漫性糖尿病黄斑水肿的临床效果。方法:收集2004-03/2006-07在我院因弥漫性糖尿病黄斑水肿性行玻璃体切割方法治疗的患者23例(23眼),所有患者均严格控制血糖、血压,术前均详细检查视力、眼压、裂隙灯、检眼镜眼底、荧光血管造影(fluorescein fundus angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT),分别记录术前术后1,3,6,12mo视力及黄斑厚度,进行对比,并观察手术后并发症,平均随访14.5±1.2mo。结果:所有患者均顺利进行玻璃体手术治疗,其中有8例患者在曲安奈德(triamcinolone acetonide,TA)辅助下完成玻璃体手术,术前患者平均视力0.24±0.15,术后1,3,6,12mo平均视力0.19±0.14,0.25±0.16,0.28±0.15,0.32±0.19,术后12mo与术前矫正视力对比有显著性差异,术前黄斑厚度平均OCT值438±169μm,术后1,3,6,12mo平均OCT值为317±123,263±87μm,237±6,228±41μm,与术前分别对比均有显著性差异。术中2例出现医源性网膜裂孔,激光封口,无患者术后出现玻璃体出血,虹膜新生血管,视网膜前膜,无患者行白内障手术。结论:玻璃体切割手术治疗弥漫性黄斑水肿可在短期内明显减轻黄斑水肿,并逐步改善患者视功能,其远期效果需进一步观察。

Effect of vitrectomy in the treatment of diffuse diabetic macular edema

AIM:To study the surgical efficacy of pars plana vitrectomy (PPV) for diffuse diabetic macular edema.METHODS: Pars plana vitrectomy was performed on 23 eyes of 23 cases with diffuse diabetic macular edema, 8 eyes of all underwent TA-assisted PPV, main outcome measures included pre-and post operation optical coherence tomography(OCT) and visual acuity(VA). Mean follow-up period was 14.5±1.4 months. RESULTS: At last follow-up , 39% of eyes had ≥ 2 line increase in VA,48% of eyes had no improvement in VA, and 13% of eyes had 2 line decrease in VA. mean preoperative vision was 0.24±0.15,Mean visual acuity at 1 month,3 months, 6 months and 12 months postoperatively was 0.19±0.14,0.25±0.16,0.28±0.15,0.32±0.19 respectively. Significantly decreased for the postoperative 12 months VA compared to preoperative, The postoperative foveal retinal thickness at 1 month,3 months, 6 months, 12 months was 317±123,263±87,237±69μm,228±41μm respectively,Significantly thinner than the preoperative foveal retinal thickness(438±169μm), other postoperative complications reported before were not met in our cases.CONCLUSION: Pars plana vitrectomy for diffuse diabetic macular edema is an effective procedure for reducing the edema thickness and can improve visual acuity gradually, but the long-term efficacy of this method should be observed. 