本文選題：增生性糖尿病視網(wǎng)膜病變 + 玻璃體切除術(shù)�。� 參考：《鄭州大學(xué)》2011年碩士論文

【摘要】：目的 增生性糖尿病視網(wǎng)膜病變(proliferative diabetic retinopathy, PDR)是糖尿病患者主要的致盲原因,也是玻璃體切除手術(shù)常見(jiàn)的適應(yīng)證。PDR常合并不同程度的白內(nèi)障,適時(shí)的玻璃體切除能使患者獲得良好的術(shù)后視力,目前玻璃體切除,超聲乳化吸出及人工晶體植入聯(lián)合手術(shù)已經(jīng)越來(lái)越多的應(yīng)用于治療PDR,本研究探討聯(lián)合手術(shù)和單純玻璃體切除術(shù)兩種術(shù)式治療增生性糖尿病視網(wǎng)膜病變的效果。 方法 回顧性分析增生性糖尿病視網(wǎng)膜病變26例(26眼)聯(lián)合手術(shù)與24例(24眼)單純玻璃體切除手術(shù),術(shù)后視力及術(shù)中、術(shù)后并發(fā)癥等臨床資料。聯(lián)合手術(shù)組26例(26眼),年齡32-82歲,平均(60.4±10.8)歲。男10例,女16例。均為單眼手術(shù)。術(shù)前視力光感-0.12,術(shù)后隨訪10-30月,平均20個(gè)月。單純玻璃體切除術(shù)組24例(24眼),年齡40-74歲,平均(59.6±9.1)歲。男12例,女12例。亦為單眼手術(shù)。術(shù)前視力手動(dòng)-0.12,術(shù)后隨訪11-31月,平均21個(gè)月。兩組50例患者白內(nèi)障程度均相似,單純玻璃體切除組中24眼在單純玻璃體切除術(shù)后,再行白內(nèi)障超聲乳化及人工晶狀體植入術(shù)。 結(jié)果 兩組患者手術(shù)后視力較術(shù)前均提高,兩組之間差異無(wú)統(tǒng)計(jì)學(xué)意義；術(shù)后前房?jī)?nèi)纖維素滲出膜形成者兩組分別有6眼和1眼,差異無(wú)統(tǒng)計(jì)學(xué)意義；術(shù)后角膜水腫兩組分別有10眼和3眼,差異有統(tǒng)計(jì)學(xué)意義；術(shù)后發(fā)生新生血管性青光眼兩組分別有2眼和1眼,差異無(wú)統(tǒng)計(jì)學(xué)意義；術(shù)后形成虹膜后粘連兩組分別有5眼和1眼,差異無(wú)統(tǒng)計(jì)學(xué)意義；術(shù)后再行玻璃體切除術(shù)兩組分別有1眼和2眼,差異無(wú)統(tǒng)計(jì)學(xué)意義；術(shù)后視網(wǎng)膜再次脫離兩組分別有1眼和3眼,差異無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論 1.玻璃體切除聯(lián)合超聲乳化吸出及人工晶狀體植入術(shù)治療增生性糖尿病視網(wǎng)膜病變是安全有效的。 2.單純玻璃體切除對(duì)于增生性糖尿病視網(wǎng)膜病變的效果也是比較滿意的PDR在合并玻璃體出血或局限性牽拉性視網(wǎng)膜脫離時(shí),應(yīng)適時(shí)地進(jìn)行玻璃體切除,以獲得較好的術(shù)后視力。 3.對(duì)于不同的患者應(yīng)根據(jù)實(shí)際情況合理選擇手術(shù)的方式,當(dāng)患者白內(nèi)障比較嚴(yán)重并且影響到玻璃體手術(shù)操作,影響術(shù)后眼底治療且經(jīng)濟(jì)情況允許時(shí),可考慮行聯(lián)合手術(shù),術(shù)后及時(shí)補(bǔ)充光凝,爭(zhēng)取最大程度的恢復(fù)視力。 4.聯(lián)合手術(shù)后前房炎性反應(yīng)、虹膜后粘連及角膜水腫的發(fā)生率比單純玻璃體切除術(shù)高,出現(xiàn)這些術(shù)后反應(yīng)時(shí)可及時(shí)對(duì)癥治療以保證術(shù)后遠(yuǎn)期療效。
[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 鹵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 鹵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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R779.6

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 杜軍輝;成靜;柴新紅;馮利;張中;;重視糖尿病視網(wǎng)膜病變的早期檢查治療[J];中華臨床醫(yī)師雜志(電子版);2011年24期

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本文編號(hào)：1769083