增生性糖尿病视网膜病变手术方式的探讨

发布时间：2018-04-18 16:07

本文选题：增生性糖尿病视网膜病变 + 玻璃体切除术　；参考：《郑州大学》2011年硕士论文

【摘要】：目的增生性糖尿病视网膜病变(proliferative diabetic retinopathy, PDR)是糖尿病患者主要的致盲原因,也是玻璃体切除手术常见的适应证。PDR常合并不同程度的白内障,适时的玻璃体切除能使患者获得良好的术后视力,目前玻璃体切除,超声乳化吸出及人工晶体植入联合手术已经越来越多的应用于治疗PDR,本研究探讨联合手术和单纯玻璃体切除术两种术式治疗增生性糖尿病视网膜病变的效果。方法回顾性分析增生性糖尿病视网膜病变26例(26眼)联合手术与24例(24眼)单纯玻璃体切除手术,术后视力及术中、术后并发症等临床资料。联合手术组26例(26眼),年龄32-82岁,平均(60.4±10.8)岁。男10例,女16例。均为单眼手术。术前视力光感-0.12,术后随访10-30月,平均20个月。单纯玻璃体切除术组24例(24眼),年龄40-74岁,平均(59.6±9.1)岁。男12例,女12例。亦为单眼手术。术前视力手动-0.12,术后随访11-31月,平均21个月。两组50例患者白内障程度均相似,单纯玻璃体切除组中24眼在单纯玻璃体切除术后,再行白内障超声乳化及人工晶状体植入术。结果两组患者手术后视力较术前均提高,两组之间差异无统计学意义；术后前房内纤维素渗出膜形成者两组分别有6眼和1眼,差异无统计学意义；术后角膜水肿两组分别有10眼和3眼,差异有统计学意义；术后发生新生血管性青光眼两组分别有2眼和1眼,差异无统计学意义；术后形成虹膜后粘连两组分别有5眼和1眼,差异无统计学意义；术后再行玻璃体切除术两组分别有1眼和2眼,差异无统计学意义；术后视网膜再次脱离两组分别有1眼和3眼,差异无统计学意义。结论 1.玻璃体切除联合超声乳化吸出及人工晶状体植入术治疗增生性糖尿病视网膜病变是安全有效的。 2.单纯玻璃体切除对于增生性糖尿病视网膜病变的效果也是比较满意的PDR在合并玻璃体出血或局限性牵拉性视网膜脱离时,应适时地进行玻璃体切除,以获得较好的术后视力。 3.对于不同的患者应根据实际情况合理选择手术的方式,当患者白内障比较严重并且影响到玻璃体手术操作,影响术后眼底治疗且经济情况允许时,可考虑行联合手术,术后及时补充光凝,争取最大程度的恢复视力。 4.联合手术后前房炎性反应、虹膜后粘连及角膜水肿的发生率比单纯玻璃体切除术高,出现这些术后反应时可及时对症治疗以保证术后远期疗效。
[Abstract]:PurposeProliferative diabetic retinopathy (PDRs) is the main cause of blindness in diabetic patients and is a common indication for vitrectomy.Timely vitrectomy can enable patients to obtain good postoperative visual acuity.Phacoemulsification and intraocular lens implantation combined with surgery have been used more and more in the treatment of PDR. This study is to investigate the efficacy of combined surgery and vitrectomy in the treatment of proliferative diabetic retinopathy.MethodThe clinical data of 26 cases of proliferative diabetic retinopathy (26 eyes) and 24 cases (24 eyes) of hyperplastic diabetic retinopathy were analyzed retrospectively.In the combined operation group, 26 eyes (32-82 years old, mean 60.4 卤10. 8) years old.There were 10 males and 16 females.All were monocular.Preoperative visual acuity-0.12, postoperative follow-up of 10-30 months, an average of 20 months.In the group of vitrectomy alone, 24 eyes (40-74 years old, mean 59. 6 卤9. 1) years of age.There were 12 males and 12 females.It is also a monocular operation.Preoperative visual acuity was manual-0.12, postoperative follow-up was 11-31 months (mean 21 months).The degree of cataract was similar in the two groups. Phacoemulsification and intraocular lens implantation were performed in 24 eyes of the simple vitrectomy group.ResultThe visual acuity of the two groups was improved after operation, and there was no significant difference between the two groups, and there were 6 eyes and 1 eye in the two groups with the formation of cellulose exudate membrane in the anterior chamber after operation, with no significant difference between the two groups.There were 10 eyes and 3 eyes of corneal edema in the two groups, the difference was statistically significant, and there were 2 eyes and 1 eye in neovascular glaucoma group, the difference was not statistically significant.There were 5 eyes and 1 eye of postoperative posterior iridectomy in the two groups, there was no significant difference between the two groups, and there was no significant difference between the two groups after vitrectomy (1 eye and 2 eyes).There were 1 eye and 3 eyes in the two groups respectively after retinal detachment, the difference was not statistically significant.Conclusion1.Vitrectomy combined with phacoemulsification and intraocular lens implantation is safe and effective in the treatment of proliferative diabetic retinopathy.2.The effect of simple vitrectomy on proliferative diabetic retinopathy is also satisfactory. When PDR is complicated with vitreous hemorrhage or local traction retinal detachment, vitrectomy should be carried out timely in order to obtain better postoperative visual acuity.3.For different patients, the operation should be reasonably selected according to the actual situation. When the cataract is more serious and affects the operation of vitreous surgery, and affects the postoperative fundus treatment and economic conditions, we may consider performing combined surgery.Timely supplement of photocoagulation after operation to maximize recovery of visual acuity.4.The incidence of anterior chamber inflammatory reaction, posterior iris adhesion and corneal edema after combined surgery is higher than that of vitrectomy alone.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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