【摘要】： 目的:觀察玻璃體切割手術(shù)治療增殖性糖尿病視網(wǎng)膜病變(proliferative diabetic retinopathy,PDR)的療效。 方法:選取2008年3月～2009年12月由本院眼底病一科同一術(shù)者完成玻璃體切割手術(shù)治療PDR患者102例(117只眼)的臨床資料進(jìn)行回顧性分析。對術(shù)后視力、手術(shù)時機(jī)、眼內(nèi)填充物的應(yīng)用及與手術(shù)相關(guān)并發(fā)癥進(jìn)行探討研究。 結(jié)果:(1)PDR IV期組36眼(85.71%),PDR V期組27眼(69.23%),PDR VI期組19眼(52.78%)術(shù)后視力提高。(2)在PDR IV期組中,玻璃體積血時間小于2個月組術(shù)后視力改善率高于2～3個月組(P=0.032);2～3個月組和大于3個月組沒有顯著的統(tǒng)計學(xué)差異(P=1.000)。(3)一次手術(shù)后總的視網(wǎng)膜解剖在位數(shù)為112眼(95.73%),PDR IV期組41眼(97.62%),PDR V期組38眼(97.44%),PDR VI期組33眼(91.67%)。(4)術(shù)后共19眼(16.24%)出現(xiàn)玻璃體再出血,保留灌注液組、C3F8填充組和硅油填充組玻璃體再出血的差異在統(tǒng)計學(xué)上無明顯意義(P=0.882)。術(shù)前行PRP組與未行PRP組術(shù)后玻璃體再出血的發(fā)生率存在統(tǒng)計學(xué)差異(P=0.042)。(5)一次術(shù)中摘除晶狀體5眼,3眼于隨訪期內(nèi)行白內(nèi)障超聲乳化手術(shù)并植入人工晶狀體。(6)術(shù)后INV發(fā)生率為5.98%(7眼)。 結(jié)論:(1)玻璃體切割手術(shù)能有效地改善增殖性糖尿病視網(wǎng)膜病變患者的視力。(2)掌握恰當(dāng)?shù)氖中g(shù)時機(jī)對預(yù)后十分重要。(3)眼內(nèi)填充物的應(yīng)用主要根據(jù)術(shù)前或術(shù)中是否存在視網(wǎng)膜裂孔。(4)術(shù)中對明確的缺血區(qū)域和裂孔進(jìn)行有效的光凝,術(shù)后屈光介質(zhì)清楚即行熒光造影并補(bǔ)充視網(wǎng)膜激光光凝可以達(dá)到良好的效果。(5)術(shù)前評估每個患者晶狀體混濁的程度,對術(shù)中的晶體進(jìn)行個性化處理。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R774.1

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