CAJ | 학술논문

目的观察2型糖尿病患者(T2DM)糖尿病视网膜病变(DR)合并视网膜中央静脉阻塞(CRVO)的临床特征及玻璃体切割手术治疗效果.方法接受玻璃体切割手术治疗的增生型DR (PDR)患者192例241只纳入研究.患者均因突然视力下降诊断为玻璃体积血.合并牵拉性视网膜脱离(TRD)93只眼、虹膜新生血管(NVI)6只眼.根据手术中眼底检查结果分为PDR合并CRVO组(A组)、单纯PDR组(B组),分别为41、200只眼.所有患者均行常规玻璃体切割手术.手术中根据需要选择填充物.硅油填充138只眼.其中,A组30只眼,B组108只眼.两组间硅油填充眼数比较,差异有统计学意义(x2 =5.110,P＜0.05).C3F8填充者38只眼.其中,A组6只眼,B组32只眼.两组间C3F8填充眼数比较,差异无统计学意义(x2=0.048,P＞0.05).手术后随访1～60个月,平均随访时间(28.69±17.28)个月.观察手术后矫正视力和手术后视网膜再脱离、持续性黄斑水肿(ME)、新生血管性青光眼(NVG)及再次玻璃体积血等并发症发生情况.结果 241只眼中合并CRVO者41只眼,占17.0％.两组患眼手术前矫正视力(Z=-0.138)、眼压(t=0.966)、合并TRD(x2=0.412)、是否行全视网膜激光光凝(PRP)治疗(x2=1.416)比较,差异均无统计学意义(P＞0.05);是否存在NVI比较,差异有统计学意义(x2=31.724,P＜0.05).两组患眼手术后矫正视力均提高,与手术前矫正视力比较,差异有统计学意义(Z=2.319、4.589,P＜0.05).两组患眼之间手术后矫正视力比较,差异无统计学意义(Z=0.782,P＞0.05).手术后发生并发症94只眼.其中,A组26只眼,B组68只眼.两组患眼之间在行2次手术眼数(x2 =0.498)、视网膜再脱离(x2 =0.818)、持续性ME(x2 =2.722)之间比较,差异均无统计学意义(P＞0.05);A组玻璃体再积血、NVG发生率较B组高,两组患眼间玻璃体再积血(x2=5.737)、NVG发生率(x2=6.604)比较,差异均有统计学意义(P＜0.05).结论 T2DM合并玻璃体积血的DR患者CRVO发生率较高;合并CRVO者更易出现NVI;玻璃体切割手术能改善PDR合并CRVO患者视功能. 目的觀察2型糖尿病患者(T2DM)糖尿病視網膜病變(DR)閤併視網膜中央靜脈阻塞(CRVO)的臨床特徵及玻璃體切割手術治療效果.方法接受玻璃體切割手術治療的增生型DR (PDR)患者192例241隻納入研究.患者均因突然視力下降診斷為玻璃體積血.閤併牽拉性視網膜脫離(TRD)93隻眼、虹膜新生血管(NVI)6隻眼.根據手術中眼底檢查結果分為PDR閤併CRVO組(A組)、單純PDR組(B組),分彆為41、200隻眼.所有患者均行常規玻璃體切割手術.手術中根據需要選擇填充物.硅油填充138隻眼.其中,A組30隻眼,B組108隻眼.兩組間硅油填充眼數比較,差異有統計學意義(x2 =5.110,P＜0.05).C3F8填充者38隻眼.其中,A組6隻眼,B組32隻眼.兩組間C3F8填充眼數比較,差異無統計學意義(x2=0.048,P＞0.05).手術後隨訪1～60箇月,平均隨訪時間(28.69±17.28)箇月.觀察手術後矯正視力和手術後視網膜再脫離、持續性黃斑水腫(ME)、新生血管性青光眼(NVG)及再次玻璃體積血等併髮癥髮生情況.結果 241隻眼中閤併CRVO者41隻眼,佔17.0％.兩組患眼手術前矯正視力(Z=-0.138)、眼壓(t=0.966)、閤併TRD(x2=0.412)、是否行全視網膜激光光凝(PRP)治療(x2=1.416)比較,差異均無統計學意義(P＞0.05);是否存在NVI比較,差異有統計學意義(x2=31.724,P＜0.05).兩組患眼手術後矯正視力均提高,與手術前矯正視力比較,差異有統計學意義(Z=2.319、4.589,P＜0.05).兩組患眼之間手術後矯正視力比較,差異無統計學意義(Z=0.782,P＞0.05).手術後髮生併髮癥94隻眼.其中,A組26隻眼,B組68隻眼.兩組患眼之間在行2次手術眼數(x2 =0.498)、視網膜再脫離(x2 =0.818)、持續性ME(x2 =2.722)之間比較,差異均無統計學意義(P＞0.05);A組玻璃體再積血、NVG髮生率較B組高,兩組患眼間玻璃體再積血(x2=5.737)、NVG髮生率(x2=6.604)比較,差異均有統計學意義(P＜0.05).結論 T2DM閤併玻璃體積血的DR患者CRVO髮生率較高;閤併CRVO者更易齣現NVI;玻璃體切割手術能改善PDR閤併CRVO患者視功能.
목적 관찰2형당뇨병환자(T2DM)당뇨병시망막병변(DR)합병시망막중앙정맥조새(CRVO)적림상특정급파리체절할수술치료효과.방법 접수파리체절할수술치료적증생형DR (PDR)환자192례241지납입연구.환자균인돌연시력하강진단위파리체적혈.합병견랍성시망막탈리(TRD)93지안、홍막신생혈관(NVI)6지안.근거수술중안저검사결과분위PDR합병CRVO조(A조)、단순PDR조(B조),분별위41、200지안.소유환자균행상규파리체절할수술.수술중근거수요선택전충물.규유전충138지안.기중,A조30지안,B조108지안.량조간규유전충안수비교,차이유통계학의의(x2 =5.110,P＜0.05).C3F8전충자38지안.기중,A조6지안,B조32지안.량조간C3F8전충안수비교,차이무통계학의의(x2=0.048,P＞0.05).수술후수방1～60개월,평균수방시간(28.69±17.28)개월.관찰수술후교정시력화수술후시망막재탈리、지속성황반수종(ME)、신생혈관성청광안(NVG)급재차파리체적혈등병발증발생정황.결과 241지안중합병CRVO자41지안,점17.0％.량조환안수술전교정시력(Z=-0.138)、안압(t=0.966)、합병TRD(x2=0.412)、시부행전시망막격광광응(PRP)치료(x2=1.416)비교,차이균무통계학의의(P＞0.05);시부존재NVI비교,차이유통계학의의(x2=31.724,P＜0.05).량조환안수술후교정시력균제고,여수술전교정시력비교,차이유통계학의의(Z=2.319、4.589,P＜0.05).량조환안지간수술후교정시력비교,차이무통계학의의(Z=0.782,P＞0.05).수술후발생병발증94지안.기중,A조26지안,B조68지안.량조환안지간재행2차수술안수(x2 =0.498)、시망막재탈리(x2 =0.818)、지속성ME(x2 =2.722)지간비교,차이균무통계학의의(P＞0.05);A조파리체재적혈、NVG발생솔교B조고,량조환안간파리체재적혈(x2=5.737)、NVG발생솔(x2=6.604)비교,차이균유통계학의의(P＜0.05).결론 T2DM합병파리체적혈적DR환자CRVO발생솔교고;합병CRVO자경역출현NVI;파리체절할수술능개선PDR합병CRVO환자시공능.
Objective To observe the clinical features and outcomes of vitrectomy for diabetic retinopathy (DR) with central retinal vein occlusion (CRVO) in type 2 diabetes mellitus (T2DM).Methods A total of 192 patients (241 eyes) with proliferative DR (PDR) who underwent vitrectomy were enrolled in this study.All the patients were diagnosed as vitreous hemorrhage (VH) because of suddenly decreased vision.There were 93 eyes with tractional retinal detachment (TRD) and six eyes with neovascularization of iris (NVI).The patients were divided into PDR with CRVO group (group A,41 eyes) and PDR group (group B,200 eyes) according to the results of fundus examination.All patients received vitrectomy with silicone oil and C3F8 gas tamponade.There were 138 eyes with silicone oil tamponade which including 30 eyes in group A and 108 eyes in group B.The difference of number in silicone oil-filled eyes in two groups was statistically significant (x2=5.110,P＜0.05).There were 38 eyes with C3F8 gas tamponade which including six eyes in group A and 32 eyes in group B.There was no difference in C3F8 gas-filled eyes numbers in two groups (x2 =0.048,P＞0.05).The follow-up ranged from one to 60 months,with the mean of (28.69± 17.28) months.The corrected vision,retinal reattachment,persisting macular edema (ME),neovascular glaucoma (NVG) and repeated VH after surgery were comparatively analyzed.Results Of 241 eyes,there were 41 eyes (17.0％) with CRVO.Before surgery,the differences of corrected vision (Z=-0.138),intraocular pressure (t=0.966),whether there was TRDor not (x2=0.412),whether underwent panretinal photocoagulation or not (x2 =1.416) were not statistically significant (P＞0.05),but the difference of whether NVI were present or not was statistically significant (x2=31.724,P＜0.05)between two groups.After surgery,the corrected vision improved in both two groups (Z=2.319,4.589;P＜0.05).There was no difference of corrected vision after surgery between two groups (Z=0.782,P＞0.05).Postoperative complications occurred in 94 eyes,including 26 eyes in group A and 68 eyes in group B.The differences of incidence of reoperation (x2 =0.498),retinal reattachment (x2 =0.818),persisting ME (x2 =2.722) between two groups after surgery were not statistically significant (P ＞ 0.05).The incidence of repeated VH (x2 =5.737) and NVG (x2 =6.604) in group A were higher than those in group B (P＜ 0.05).Conclusions CRVO is commonly found to coexist with DR in T2DM patients with VH.Combined with CRVO patients are more likely to suffer NVI.Vitrectomy can improve the visual function in PDR with CRVO patients.