102例（117只眼）增殖性糖尿病视网膜病变手术治疗的临床分析

发布时间：2018-07-21 14:42

【摘要】： 目的:观察玻璃体切割手术治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的疗效。方法:选取2008年3月～2009年12月由本院眼底病一科同一术者完成玻璃体切割手术治疗PDR患者102例(117只眼)的临床资料进行回顾性分析。对术后视力、手术时机、眼内填充物的应用及与手术相关并发症进行探讨研究。结果:(1)PDR IV期组36眼(85.71%),PDR V期组27眼(69.23%),PDR VI期组19眼(52.78%)术后视力提高。(2)在PDR IV期组中,玻璃体积血时间小于2个月组术后视力改善率高于2～3个月组(P=0.032);2～3个月组和大于3个月组没有显著的统计学差异(P=1.000)。(3)一次手术后总的视网膜解剖在位数为112眼(95.73%),PDR IV期组41眼(97.62%),PDR V期组38眼(97.44%),PDR VI期组33眼(91.67%)。(4)术后共19眼(16.24%)出现玻璃体再出血,保留灌注液组、C3F8填充组和硅油填充组玻璃体再出血的差异在统计学上无明显意义(P=0.882)。术前行PRP组与未行PRP组术后玻璃体再出血的发生率存在统计学差异(P=0.042)。(5)一次术中摘除晶状体5眼,3眼于随访期内行白内障超声乳化手术并植入人工晶状体。(6)术后INV发生率为5.98%(7眼)。结论:(1)玻璃体切割手术能有效地改善增殖性糖尿病视网膜病变患者的视力。(2)掌握恰当的手术时机对预后十分重要。(3)眼内填充物的应用主要根据术前或术中是否存在视网膜裂孔。(4)术中对明确的缺血区域和裂孔进行有效的光凝,术后屈光介质清楚即行荧光造影并补充视网膜激光光凝可以达到良好的效果。(5)术前评估每个患者晶状体混浊的程度,对术中的晶体进行个性化处理。
[Abstract]:Objective: to observe the effect of vitrectomy on proliferative diabetic retinopathy (proliferative diabetic). Methods: the clinical data of 102 cases (117 eyes) of PDR treated by vitrectomy from March 2008 to December 2009 were retrospectively analyzed. The visual acuity, the timing of operation, the application of intraocular fillers and the complications associated with surgery were studied. Results: (1) postoperative visual acuity was improved in 36 eyes (85.71%) of PDR IV group, 27 eyes (69.23%) in PDR V phase group, 19 eyes (52.78%) in PDR VI stage group, (2) in PDR IV stage group, 19 eyes (52.78%) in PDR IV stage group. The visual acuity improvement rate of vitreous hemorrhage less than 2 months group was higher than that of 2 ~ 3 months group (P0. 032) and more than 3 months group (P < 1. 000). (3). The total number of retina anatomical position after one operation was 112 eyes. (95.73%) of 41 eyes (97.62%) in PDRIV group, 38 eyes (97.44%) in PDRV stage group, 33 eyes (91.67%). (4) in PDRVI stage group, 19 eyes (16.24%) had vitreous rebleeding after operation. There was no significant difference in vitreous rebleeding between C _ 3F _ 8 filling group and silicone oil filling group (P < 0. 882). The incidence of vitreous rebleeding in PRP group was significantly different from that in PRP group (P0. 042). (5). Cataract phacoemulsification and intraocular lens implantation were performed in 3 eyes during the follow-up period. (6) the incidence of postoperative intravitreal hemorrhage was 5.98% (7 eyes). Conclusion: (1) vitrectomy can effectively improve the visual acuity of proliferative diabetic retinopathy. (2) it is very important for the prognosis to grasp the appropriate operative timing. (3) the application of intraocular fillings is mainly based on whether or not the intraocular filling exists before or during the operation. (4) effective photocoagulation of definite ischemic areas and holes during the operation. Fluorescence angiography and retinal laser photocoagulation can achieve good results. (5) evaluate the degree of lens opacity in each patient before operation and individualize the intraoperative lens.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.1

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