91例视网膜血管性疾病行玻璃体切除术联合眼内激光光凝的临床分析
发布时间：2019-03-28 13:30
【摘要】：目的：探讨行玻璃体切除术联合眼内激光光凝治疗视网膜血管性疾病的病因构成，，手术后视力及其影响因素，以更好地指导视网膜血管性疾病的治疗。 方法：对我院眼科2009年9月至2011年10月期间收治的因视网膜血管性疾病行玻璃体切除术联合眼内激光光凝治疗的91例患者（100只眼）的临床资料进行回顾性分析。 结果：（1）91例患者100只眼中，PDR57人66只眼，年龄25～73岁，平均年龄54.23±9.85岁。BRVO10人10只眼，年龄41～75岁，平均年龄66.5±9.77岁。CRVO3人3只眼，年龄43～69岁，平均年龄58±13.45岁。HRP12人12只眼，年龄39～62岁，平均年龄55.08±7.10岁。Eales病9人9只眼，年龄19～59岁，平均年龄40.67±13.31岁。（2）手术前后视力比较有显著的统计学差异（P=0.0000.05）。（3）不同疾病的术后视力改善率的差异无统计学意义（P=0.4720.05）。（4）PDR IV期术后视力改善率高于PDR V期和PDR VI期(P_(IV-V)=0.0100.0167, P_(IV-V)I=0.0040.0167)，PDR V期与PDR VI期术后视力改善率的差异无统计学意义（P_(V-VI)=0.6570.0167）。（5）术前行PRP的PDR与术前未行PRP的PDR术后视力改善率的差异比较无统计学意义（P=0.1620.05）。（6）PDR IV期玻璃体积血小于2个月的视力改善率比大于2个月的视力改善率高（P=0.029＜0.05）；RVO致玻璃体积血小于2个月和大于2个月视力改善率的差异无统计学意义（P=0.5920.05）。HRP致玻璃体积血小于2个月的视力改善率比大于2个月的视力改善率高（P=0.010＜0.05）。（7）术后未使用填充物组有41只眼（68.3%）视力改善，C3F8填充组有9只眼（37.5%）视力改善，硅油填充组有7只眼（43.8%）视力改善。（8）术中摘除白内障24只眼，白内障摘除联合人工晶体植入的术后视力改善率（78.6%）高于保留晶状体的术后视力改善率（55.3%）和白内障摘除但未植入人工晶体的术后视力改善率（40.0%）。（9）术后并发症包括早期眼压升高、角膜水肿、玻璃体积血、黄斑囊样水肿、新生血管性青光眼、并发性白内障、视网膜脱离、视网膜中央动脉阻塞。 结论：（1）并发严重玻璃体积血和/或玻璃体视网膜增殖性改变的视网膜血管性疾病，行玻璃体切除术联合眼内激光光凝是挽救视力的有效方法。（2）视网膜血管性疾病术后的视力与原始疾病严重程度密切相关。（3）PDR患者早期行玻璃体切除术联合眼内激光光凝可以取得较好的预后视力。
[Abstract]:Aim: to investigate the etiological factors of vitrectomy combined with laser photocoagulation in the treatment of retinal vascular diseases (RVD), so as to better guide the treatment of retinal vascular diseases (RVD). Methods: the clinical data of 91 patients (100 eyes) who underwent vitrectomy combined with laser photocoagulation for retinal vascular diseases from September 2009 to October 2011 in our hospital were retrospectively analyzed. Results: (1) of the 91 patients, 66 eyes were PDR57 (age 25-73 years, mean age 54.23 卤9.85 years), 10 eyes were BRVO10 patients (41-75 years old, mean age 66.5 卤9.77 years), 3 eyes were CRVO3 people, and the average age was 43-69 years. The mean age of HRP12 was 58 卤13.45 years old (12 eyes, 39 卤62 years old, 55.08 卤7.10 years old), 9 eyes of 9 patients with Eales disease, 19 eyes of 59 cases of Eales disease, 9 eyes of 9 patients and 9 eyes of 9 patients with Eales' disease. The mean age was 40.67 卤13.31 years old. (2) there was a significant difference in postoperative visual acuity improvement rate between pre-and post-operative visual acuity (P = 0.0000.05). (3). There was no significant difference in postoperative visual acuity improvement rate between different diseases (P = 0.4720.05). (the visual acuity improvement rate of 4) PDR IV stage was higher than that of PDR V stage and PDR VI stage (P _ (IV-V) = 0.0100.0167, P _ (IV-V). P _ (IV-V) I _ (0.0040.0167), There was no significant difference in the postoperative visual acuity improvement rate between PDR V stage and PDR VI stage (P _ (V-VI) = 0.6570.0167). (5). There was no significant difference in the visual acuity improvement rate between pre-operation PDR and PDR without preoperative PRP (P _ (V-VI) = 0.6570.0167). (5). (P < 0. 1620.05). (6 -) PDR IV stage), the visual acuity improvement rate of vitreous hemorrhage less than 2 months was higher than that of more than 2 months (P < 0.05), and the visual acuity improvement rate of the patients with vitreous hemorrhage less than 2 months was higher than that of the patients with more than 2 months. There was no significant difference in visual acuity improvement rate between RVO-induced vitreous hemorrhage less than 2 months and more than 2 months (P < 0. 5920.05). HRP-induced vitreous hemorrhage less than 2 months), compared with vision improvement rates more than 2 months after vitreous hemorrhage (P < 0. 5920.05). HRP). The visual acuity of 41 eyes (68.3%) in the high (P < 0.05). (7) group after operation was improved, and the visual acuity was improved in 41 eyes (68.3%) in the non-filled group. In C3F8-filled group, visual acuity improved in 9 eyes (37.5%), in silicone oil-filled group in 7 eyes (43.8%). (8) Cataract was removed in 24 eyes during operation, and the visual acuity was improved in 7 eyes (43.8%) in silicone oil-filled group. The visual acuity improvement rate after cataract extraction combined with IOL implantation (78.6%) was higher than that after lens preservation (55.3%) and after cataract extraction without IOL implantation, the visual acuity improvement rate after cataract extraction without IOL implantation was higher than that after cataract extraction without IOL implantation (78.6%). (40. 0%). (- 9) postoperative complications included early elevation of intraocular pressure (IOP). Corneal edema, vitreous blood, macular cystic edema, neovascular glaucoma, complicated cataract, retinal detachment, central retinal artery occlusion. Conclusion: (1) Retinal vascular diseases complicated with severe vitreous hemorrhage and / or vitreoretinal proliferative changes. Vitrectomy combined with laser photocoagulation is an effective method to save visual acuity. (2) postoperative visual acuity of retinal vascular disease is closely related to the severity of primary disease. (3) early vitrectomy is performed in PDR patients. Combined with intraocular laser photocoagulation, better visual acuity can be obtained.
【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
本文编号：2448912
[Abstract]:Aim: to investigate the etiological factors of vitrectomy combined with laser photocoagulation in the treatment of retinal vascular diseases (RVD), so as to better guide the treatment of retinal vascular diseases (RVD). Methods: the clinical data of 91 patients (100 eyes) who underwent vitrectomy combined with laser photocoagulation for retinal vascular diseases from September 2009 to October 2011 in our hospital were retrospectively analyzed. Results: (1) of the 91 patients, 66 eyes were PDR57 (age 25-73 years, mean age 54.23 卤9.85 years), 10 eyes were BRVO10 patients (41-75 years old, mean age 66.5 卤9.77 years), 3 eyes were CRVO3 people, and the average age was 43-69 years. The mean age of HRP12 was 58 卤13.45 years old (12 eyes, 39 卤62 years old, 55.08 卤7.10 years old), 9 eyes of 9 patients with Eales disease, 19 eyes of 59 cases of Eales disease, 9 eyes of 9 patients and 9 eyes of 9 patients with Eales' disease. The mean age was 40.67 卤13.31 years old. (2) there was a significant difference in postoperative visual acuity improvement rate between pre-and post-operative visual acuity (P = 0.0000.05). (3). There was no significant difference in postoperative visual acuity improvement rate between different diseases (P = 0.4720.05). (the visual acuity improvement rate of 4) PDR IV stage was higher than that of PDR V stage and PDR VI stage (P _ (IV-V) = 0.0100.0167, P _ (IV-V). P _ (IV-V) I _ (0.0040.0167), There was no significant difference in the postoperative visual acuity improvement rate between PDR V stage and PDR VI stage (P _ (V-VI) = 0.6570.0167). (5). There was no significant difference in the visual acuity improvement rate between pre-operation PDR and PDR without preoperative PRP (P _ (V-VI) = 0.6570.0167). (5). (P < 0. 1620.05). (6 -) PDR IV stage), the visual acuity improvement rate of vitreous hemorrhage less than 2 months was higher than that of more than 2 months (P < 0.05), and the visual acuity improvement rate of the patients with vitreous hemorrhage less than 2 months was higher than that of the patients with more than 2 months. There was no significant difference in visual acuity improvement rate between RVO-induced vitreous hemorrhage less than 2 months and more than 2 months (P < 0. 5920.05). HRP-induced vitreous hemorrhage less than 2 months), compared with vision improvement rates more than 2 months after vitreous hemorrhage (P < 0. 5920.05). HRP). The visual acuity of 41 eyes (68.3%) in the high (P < 0.05). (7) group after operation was improved, and the visual acuity was improved in 41 eyes (68.3%) in the non-filled group. In C3F8-filled group, visual acuity improved in 9 eyes (37.5%), in silicone oil-filled group in 7 eyes (43.8%). (8) Cataract was removed in 24 eyes during operation, and the visual acuity was improved in 7 eyes (43.8%) in silicone oil-filled group. The visual acuity improvement rate after cataract extraction combined with IOL implantation (78.6%) was higher than that after lens preservation (55.3%) and after cataract extraction without IOL implantation, the visual acuity improvement rate after cataract extraction without IOL implantation was higher than that after cataract extraction without IOL implantation (78.6%). (40. 0%). (- 9) postoperative complications included early elevation of intraocular pressure (IOP). Corneal edema, vitreous blood, macular cystic edema, neovascular glaucoma, complicated cataract, retinal detachment, central retinal artery occlusion. Conclusion: (1) Retinal vascular diseases complicated with severe vitreous hemorrhage and / or vitreoretinal proliferative changes. Vitrectomy combined with laser photocoagulation is an effective method to save visual acuity. (2) postoperative visual acuity of retinal vascular disease is closely related to the severity of primary disease. (3) early vitrectomy is performed in PDR patients. Combined with intraocular laser photocoagulation, better visual acuity can be obtained.
【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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