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目的探讨玻璃体手术治疗增生性糖尿病视网膜病变(proliferativediabeticretinopathy,PDR)的时机及疗效。设计回顾性、对照干预研究。研究对象118例(120眼)PDR患者,其中88例(90眼)行玻璃体手术,30例(30眼)行常规全视网膜光凝(panretinalphotocoagulation,PRP)。方法患者分为三组,第一组为Ⅳ期PDR合并玻璃体积血50例(52眼),其病程在3个月以内行玻璃体手术者35例(37眼),病程≥6个月行玻璃体手术者15例(15眼);第二组为Ⅴ期PDR无玻璃体积血60例(60眼),其中30例行玻璃体手术,30例行PRP治疗;第三组Ⅵ期PDR8例(8眼)行玻璃体手术。主要指标视力和术中、术后并发症。结果随访3～48个月,第一组中1型糖尿病患者病程在3个月以内和6个月以上手术者相比,术后视力>0.1者分别为10眼(83.3%)和2眼(33.3%),差异有显著性(P<0.05)。2型糖尿病患者术后视力>0.1者分别为9眼(36%)和3眼(33%),无显著性差异(P>0.05);第二组均为2型糖尿病患者,接受手术者术后视力>0.1的10眼(33.3%),与术前比较差异有显著性(P<0.01)。接受PRP者治疗前、后视力比较差异不显著;第三组手术前、后视力比较,差异无显著性。术中首要并发症为视网膜医源性裂孔,术后并发症为玻璃体再出血、视网膜脱离。结论PDR患者尤其是进行性加重者,早期行玻璃体手术联合PRP,视力预后优于保守治疗者。
Objective To investigate the timing and efficacy of vitreous surgery in the treatment of proliferative diabetic retinopathy (PDR). Design retrospective, controlled intervention study. METHODS: A total of 118 patients (120 eyes) with PDR underwent vitreous surgery in 88 eyes (90 eyes) and conventional panretinal photocoagulation (PRP) in 30 eyes. Methods The patients were divided into three groups. The first group was 50 cases (52 eyes) of stage Ⅳ PDR with vitreous hemorrhage. The course of the disease was 35 cases (37 eyes) with vitreous operation within 3 months and the duration of disease was more than 6 months. (15 eyes). The second group was stage Ⅵ PDR without vitreous hemorrhage in 60 cases (60 eyes), of which 30 cases were performed vitrectomy and 30 cases were treated with PRP. The third stage Ⅵ PDR8 cases (8 eyes ) Performed vitrectomy. The main indicators of visual acuity and intraoperative and postoperative complications. Results The follow-up ranged from 3 to 48 months. In the first group, the duration of disease in patients with type 1 diabetes was less than 3 months and that of those with more than 6 months after operation. The postoperative visual acuities> 0.1 were 10 eyes (83.3%) and 2 eyes 33.3%), the difference was significant (P <0.05). There was no significant difference in visual acuity> 0.1 in patients with type 2 diabetes mellitus (P> 0.05) after 9 eyes (36%) and 3 eyes (33%) respectively. Patients in type 2 diabetes mellitus Postoperative visual acuity> 0.1 of 10 eyes (33.3%), compared with the preoperative difference was significant (P <0.01). There was no significant difference in visual acuity between the two groups before and after PRP treatment. There was no significant difference in visual acuity between the three groups before and after surgery. The primary intraoperative complications of retinal iatrogenic hiatus, postoperative complications of vitreous hemorrhage, retinal detachment. Conclusions Patients with PDR, especially those with progressive exacerbations, were treated with vitrectomy combined with PRP in the early stage. The prognosis of PDR was better than that of conservative treatment.