玻璃体腔硅油或C3F8填充对增生型糖尿病视网膜病变并发单纯玻璃体积血玻璃体切割手术疗效的影响

目的 观察玻璃体切割手术中玻璃体腔硅油或C₃F₈填充对增生型糖尿病视网膜病变（PDR）并发单纯玻璃体积血手术后疗效及并发症的影响。方法 回顾性研究。接受玻璃体切割手术治疗的PDR并发单纯玻璃体积血患者86例101只眼纳入研究。根据玻璃体腔填充物不同分为硅油组和C₃F₈组。前者28例34只眼，后者58例67只眼。分别采用硅油、C₃F₈填充。2组患者性别、年龄、糖尿病病程、空腹血糖、高血压病病史、糖尿病肾病病史、心脑血管疾病病史、体重指数、吸烟史等比较，差异均无统计学意义。2组患眼手术前视力比较，差异有统计学意义（Z=-2.604，P=0.009）。2组患眼手术前眼压比较，差异无统计学意义（Z=0.064，P=0.949）。手术除玻璃体腔填充物不同外，其余操作均一样。手术后随访1～47个月，平均随访时间（20.3±16.4）个月。手术后随访观察视力、眼压、晶状体、新生血管性青光眼（NVG）、视网膜脱离、再次玻璃体积血及2次手术等并发症发生情况。结果 2组患眼手术前后视力比较，差异有统计学意义（Z_硅油=-3.932，P=0.000；Z_C3F8=-8.326，P=0.000）；2组间患眼手术后视力比较，差异有统计学意义（Z=-1.879，P=0.040）。2组患眼手术前和手术后眼压比较，差异有统计学意义（t_硅油=-3.159，P=0.006；t_C3F8=-2.703，P=0.009）；2组间患眼手术后眼压比较，差异有统计学意义（Z=-3.593，P=0.000）。2组患眼手术后2次手术、视网膜再脱离、玻璃体再积血和NVG的发生率比较，差异有统计学意义（t=-2.777、-2.102、-2.013、-2.308，P均＜0.05）。结论 PDR并发单纯玻璃体积血者玻璃体切割手术中玻璃体腔硅油填充较C3F8填充在降低手术后并发症方面效果更好，不影响手术后视力恢复。

Effects of vitrectomy combined with intraocular silicon oil or C3F8 tamponade on vitreous hemorrhage due to proliferative diabetic retinopathy

Objective To observe the effect and complications of vitrectomy combined with intraocular silicon oil or C₃F₈ filling for proliferative diabetic retinopathy (PDR). Methods Eighty-six consecutive patients (101 eyes) with PDR-related vitreous hemorrhage who underwent primary standard three-port vitrectomy and intraocular tamponade of silicone oil or C₃F₈  were included in this retrospective study. They were divided into silicone oil group and C₃F₈  groups. There was no statistically significant difference between these two groups of patients for gender, age, duration of diabetes, fasting glucose, history of hypertension, diabetic kidney disease history, history of cardiac and vascular diseases, body mass index and smoking history. There was statistically significant difference between these two groups of patients for visual acuity (Z=-2.604, P=0.009). There was no statistically significant difference between these two groups of patients for intraocular pressure before surgery (Z=0.064, P=0.949). The mean follow-up was (20.3±16.4) months with a range from 1 to 47 months. The patients were followed up for visual acuity, intraocular pressure, neovascular glaucoma (NVG), the incidence of retinal detachment, recurrent vitreous hemorrhage, and repeated operation for complications. Results Visual acuity (t=-3.932,-8.326;P=0.000,0.000) and intraocular pressure (t=-3.159, -2.703;P=0.006, 0.009) were changed significantly after surgery for both groups. Between these two groups after surgery, there were significant differences of visual acuity (Z=-1.879,P=0.040), intraocular pressure (Z=-3.593, P=0.000), and complications (revision operation, retinal detachment, recurrent vitreous hemorrhage and NVG) (t=-2.777,-2.102, -2.308, -2.013;P＜0.05). Conclusion Intraocular silicone oil tamponade can reduce the postoperative complications of PDR, especially for severe retinal neovascularization, exudation associated with retinal edema.