糖尿病性视网膜病变（Ⅵ期）玻璃体切割术中光凝量对术后疗效的影响分析

发布时间：2018-04-25 01:41

本文选题：全视网膜激光光凝术 + 糖尿病性视网膜疾病　；参考：《吉林大学》2012年硕士论文

【摘要】：目的：评价糖尿病性视网膜病变（VI期）（proliferative diabeticretinopathy，PDR）玻璃体切割术中光凝量对术后疗效的影响分析；术中适当的光凝量与术后疗效存在一定积极的联系。方法：分析2010年1月至2011年6月，选取56例吉林大学第二医院糖尿病性视网膜病变（VI期）患者玻璃体切割术58只眼，除外术前行激光光凝术，，在性别、眼别、年龄、病程、血糖控制水平上均无统计学差异。按照统计的术中有效激光点数分组，以800点以下、800~1500点、1500点以上分为A、B、C三组。随访半年，探讨术中激光量对术后疗效的影响分析，分别从短期和长期的视力、眼压、眼内再出血、视网膜新生血管是否消退等方面研究。结果：（1）研究组中47眼（81.03%）术后视力提高，其中A组14眼（73.68%），B组19眼（86.36%），C组14眼（82.35%），三组间术后视力提高无统计学差异（P=0.642）。（2）本研究组中术后（一周内）高眼压共30眼（51.72%），其中A组9眼（47.37%），B组13眼（59.10%），C组8眼（47.06%），A组、B组和C组间术后（一周内）眼压不存在统计学差异（P=0.677）；术后随访一个月以上，高眼压共8眼（13.79%），其中A组6眼（31.58%），B组1眼（4.55%），C组1眼（5.88%），三组比较，激光量不同与眼压存在统计学差异（P=0.043）。（3）术后（一周内）眼内再出血共13眼（22.41%），其中A组5眼（23.32%），B组4眼（18.18%），C组4眼（23.53%），三组间比较，不存在统计学差异（P=0.857）；术后3周以上，共6眼（10.34%）发生眼内再出血，其中A组5眼（26.31%），B组1眼（4.55%），C组未发现眼内再出血，三组比较存在统计学差异（P=0.020）。（4）所研究组58眼中一次性视网膜解剖复位成功55眼(94.83%)，A组17眼（97.62%），B组21眼（95.45%），C组17眼（100%）。结论：（1）PRP术能有效地降低增殖性糖尿病性视网膜病变者致盲的风险。（2）适当的光凝量降低了玻璃体切割术后眼内再出血的发生率，并且能有效的控制眼压平稳，使眼底供血的最优化分配，延缓了疾病的恶化。（3）激光量不足增加了眼底再出血和眼压控制不良的风险。(4)PRP术与术后视力提高无明显联系。
[Abstract]:Objective: to evaluate the effect of photocoagulation during vitrectomy on postoperative efficacy in patients with diabetic retinopathy (PDR), and there was a positive correlation between the appropriate amount of photocoagulation and the postoperative effect. Methods: from January 2010 to June 2011, 58 eyes of 56 patients with diabetic retinopathy (stage VI) in the second Hospital of Jilin University were treated with laser photocoagulation before operation except for sex, eye type, age, course of disease. There was no statistical difference in blood glucose control level. According to the number of effective laser points in operation, three groups were divided into three groups: the number of points below 800 points was more than 1500 points and the number of points was more than 1500 points. To investigate the effect of intraoperative laser volume on postoperative curative effect, the short-term and long-term visual acuity, intraocular pressure, intraocular rebleeding and retinal neovascularization were studied. Results in the study group, 47 eyes (81.03 eyes) had improved visual acuity after operation. There were 14 eyes in group A, 73.68 eyes in group B, 19 eyes in group B, 19 eyes in group C, 14 eyes in group C, 14 eyes in group C, and 14 eyes in group C, there was no significant difference in postoperative visual acuity among the three groups. There was no significant difference in postoperative visual acuity between the three groups. In this study group, there were 30 eyes with high IOP (within one week) after operation (within one week). Among them, 9 eyes in group A, 9 eyes in group B, 13 eyes in group C, 59.10 eyes in group C, 8 eyes in group A, group A, and group C, group A, group A, group A, group A, group A, group A, group B and group C, group B and group C, 8 eyes. There was no significant difference in intraocular pressure between the two groups (within one week), and the postoperative follow-up was more than one month. The IOP was 13.79 in 8 eyes, of which 6 eyes in group A (31.58 eyes) and 1 eye in group B (4.55 eyes) and 1 eye in group C (5.88%) were compared. There were statistical differences between laser volume and intraocular pressure (P < 0.043) and intraocular hemorrhage in 13 eyes (within one week). Among them, 5 eyes in group A had intraocular hemorrhage, 5 eyes in group A and 4 eyes in group B, 4 eyes in group B and 18.18% in group C, there was no statistical difference between the three groups (P > 0.857), and there was no statistical difference between the three groups (P > 3 weeks after operation). Intraocular rebleeding occurred in 6 eyes (10.34%), and no intraocular rebleeding was found in group A (5 eyes), group B (1 eye) and group B (1 eye). There were statistical differences among the three groups (P < 0.020). In the study group, 55 eyes (94.83 eyes) of 58 eyes in the study group were successfully reattached once, and 17 eyes (97.62%) in group A had 17 eyes (97.62%) and 21 eyes (21 eyes) in group B were compared with 17 eyes in group C (17 eyes). Conclusion ProprP can effectively reduce the risk of blindness in patients with proliferative diabetic retinopathy. Proper photocoagulation can reduce the incidence of intraocular rebleeding after vitrectomy, and can effectively control intraocular pressure. The optimal distribution of blood supply to the fundus delayed the deterioration of the disease. The insufficient amount of laser increased the risk of rebleeding in the fundus and the risk of poor intraocular pressure control. There was no significant correlation between PRP and postoperative visual acuity.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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