【摘要】 目的: 探讨超声乳化联合玻璃体切除和后路晶体切除术联合玻璃体切除两种手术方式在白内障合并增生性糖尿病视网膜病变(PDR)治疗中的临床疗效。方法：分析79例PDR,共100眼,随机分为2组,术式1组53只眼,为白内障超声乳化术后,行闭合式三通道玻璃体切除,囊袋内植入后房型人工晶体;术式2组47只眼,为经扁平部玻璃体联合晶体切除术,保留前囊，人工晶体植入前囊上、睫状体沟内。结果：术后随访3个月～2年,术式1组视力改善41只眼,占77.36%;术式2组视力改善30只眼,占63.83%,两组术后视力改善眼数比较差异有统计学意义(χ2=4.76, P<0.05)。术式1组术后发生虹膜新生血管(INV)1只眼,占1.8%;术式2组术后发生INV7只眼,占14.9%,两组术后INV发生率差异有统计学意义(χ2=5.84, P<0.05)。结论: 在治疗白内障合并PDR患者中,术式1组优于术式2组,其术后并发症和INV的发生率也明显低,可使大多数患者的视力改善。
【关键词】 超声乳化术 增生性糖尿病视网膜病变 玻璃体切除术 晶状体切除术 虹膜新生血管
Combined surgery in the treatment of proliferative diabetic retinopathy and cataract
YE Nan, ZHANG Jinsha
(Xinjiang Medical University, Urumqi 830054, China)
Abstract: Objective: To investigate the efficacy of phacoemulsification or pars plana lensectomy combined with vitrectomy in the treatment of proliferative diabetic retinopathy and cataract. Methods: Seventynine cases (100eyes) with PDR and cataract who were undergone two different combined surgery from May 2003 to Dec 2006 in our hospital were reviewed, the cases were divided into two groups. Group1 was treated with the techniques included phacoemulsification. Combined vitrectomy in 53 eyes, IOL was inserted into the introcapsule via the corneascleral incision. Group 2 was treated with the techniques of lensectomy via the pars plana combined posterior segment surgeries in 47eyes, the anterior capsule was preserved and the epithelium was suctioned and scraped off, IOL was inserted via the corneascleral incision on the anterior capsule, of which the center area 4.5～5 mm in diameter was cut. Results: Seventynine cases including 100 eyes after surgery were followedup for 2 months to 3 years. Postoperatively, There were significanted differences between two groups. In visual improvement which was achieved in 41 eyes (77.36%) in group 1, in 31 eyes (63.83%) in group 2. There were significant difference between, two, groupsin, visual, improvement (χ2=4.76, P<0.05). Iris neovascularization (INV) occurred in one eye in group 1(1.8%) and 7 eyes in group 2(14.9%) during 1.5～11 months. After, surgery (χ2=5.84, P<0.05). Conclusions: Phacoemusification and simultaneous introcapsule lens implantation combined with vitrectomy in the treatment of proliferative diabetic retinopathy and cataract is more effective than pars plana lensectomy combined with vitrectomy. The surgery obviously improves the visual outcome in the majority of selected eyes with less significant complications and less iris neovascularization (INV).
Key words: phacoemusification; proliferatived diabetic retinophathy; vitrectomy; lensectomy; iris neovascularization
随着玻璃体手术器械的改进和手术技术的提高，玻璃体切除术不仅成为治疗玻璃体视网膜病变的有效手段[1]，而且使白内障伴严重玻璃体混浊同时手术成为可能。增生性糖尿病视网膜病变(PDR)是糖尿病最严重的并发症之一,而PDR的患者多合并有不同程度的白内障,且糖尿病患者的白内障比普通年龄相关性白内障发生早,并进展成熟快[2]。因此,在PDR的治疗过程中,玻璃体联合晶状体的切除手术是必需的。目前,国内外不同的联合术式报道的临床疗效不甚一致[3～7]，且有研究认为PDR患者经晶状体手术后视网膜病变的发展加速,同时虹膜新生血管(INV)形成增加[8,9]。本文回顾性分析了79例PDR(100只眼)经两种不同联合术式治疗后其视力恢复、并发症及虹膜新生血管的发生情况,现报道如下。
1资料与方法
1.1临床资料自2003年5月～2006年12月因PDR合并白内障行玻璃体切除+眼内光凝联合白内障超声乳化和晶体切除+同期人工晶体植入共79例(100眼),随机分为两组:(1)超声乳化+玻璃体切除组(术式1组),共41例(56眼),男性17例,单眼手术14例,双眼手术3例(6眼);女性24例,单眼手术12例,双眼手术12例(24眼)。(2)晶体切除+玻璃体切除组(术式2组),共38例(50眼),男性12例,单眼手术10例,双眼手术2例(4眼);女性26例,单眼手术17例,双眼手术9例(18眼)。两组年龄为35～76岁,平均54岁。Ⅰ型糖尿病10例,术式1组6例,术式2组4例;Ⅱ型糖尿病58例,术式1组30例,术式2组28例.。按照我国1984年糖尿病视网膜病变分型分期标准,术式1组中,Ⅳ期30只眼,V期12只眼,Ⅵ期6只眼;术式2组中,Ⅳ期31只眼,Ⅴ期11只眼,Ⅵ期6只眼。入院眼部检查均发现有不同程度的玻璃体积血和纤维增殖,同时有明显程度不同的白内障。术式1组中15只眼,术式2组中10只眼可见有赤道及周边区视网膜斑片状的无灌注区,术式1组中4只眼,术式2组中6只眼眼底后极部及黄斑区中心凹无血管区比正常增宽,显示无灌注区累及黄斑;另外,术式1组中4只眼,术式2组共3只眼有黄斑囊样水肿的眼底,后期见黄斑区有花瓣状荧光甚至可见有荧光的花瓣状或卵石状有分隔的囊样形态。对眼底不能窥清者均用OTIiSCAN(加拿大)超声仪行眼部AB超检查并行视觉电生理检查,术前B超显示有5只眼有局限的牵引性视网膜脱离,范围均局限在1个象限,1～2个PD。对所有的病例均行常规眼压、房角镜检查,了解有无虹膜新生血管(INV),术前无一例有虹膜新生血管(INV)。术前15例24只眼有视网膜激光光凝治疗史,其中8只眼曾激光治疗3～4次。术后1～2周复查1次,每次均行裂隙灯散瞳检查及眼压检查,仔细记录所有患者的视力、眼压、INV有无情况及视网膜情况,1～2个月所有病例行眼底荧光造影。
[1] [2] [3] 下一页 |
