CAJ | 학술논문

背景玻璃体切割术是治疗2型糖尿病患者增生性糖尿病视网膜病变(PDR)的有效方法,但术后再次出现玻璃体积血是导致患者视力再次下降的主要原因之一.目的分析2型糖尿病PDR患者行玻璃体切割术后玻璃体再积血的相关因素,探讨其预防及处理方法.方法采用系列病例回顾性研究的方法,收集2006年2月至2012年12月在首都医科大学宣武医院及北京同仁医院接受玻璃体切割术的305例2型糖尿病PDR患者305例305眼的临床资料,对其中14例14眼术后发生玻璃体积血的原因、表现和治疗效果进行分析.结果 305例糖尿病PDR患者接受玻璃体切割术后发生玻璃体积血者14例,发生率为4.6％,其中3例眼底病变为PDRⅣ期,4例为Ⅴ期,7例为Ⅵ期.14眼均经标准睫状体切口玻璃体切割术,术中均给予眼内激光光凝,1眼行巩膜外冷凝术,8眼行玻璃体腔内硅油填充.首次玻璃体切割术后6眼视力提高,4眼术后视力无改变,4眼视力较术前下降.术后再次出现玻璃体积血的时间为术后l ～7d者9眼,术后8d～3个月者1眼,术后3～6个月者2眼,术后6个月以上者2眼.玻璃体再积血的原因主要为新生血管膜残留、激光光凝范围和强度不足、新生血管形成及血糖浓度不稳定.5眼药物治疗后玻璃体积血吸收,9眼再次行玻璃体手术.最终9眼视力提高,2眼视力不变,3眼视力下降;13眼患眼视网膜复位,l眼硅油填充术后视网膜仍未复位.结论 PDR行玻璃体切割术后玻璃体再积血多发生于术后1周内,与视网膜新生血管残留、眼内激光光凝不充分及血糖水平控制欠佳有关.出血量较少的患者玻璃体积血可以自行吸收或可行药物治疗,出血量较大且持续不吸收的患者需要再次行玻璃体切割术.
배경 파리체절할술시치료2형당뇨병환자증생성당뇨병시망막병변(PDR)적유효방법,단술후재차출현파리체적혈시도치환자시력재차하강적주요원인지일.목적 분석2형당뇨병PDR환자행파리체절할술후파리체재적혈적상관인소,탐토기예방급처리방법.방법 채용계렬병례회고성연구적방법,수집2006년2월지2012년12월재수도의과대학선무의원급북경동인의원접수파리체절할술적305례2형당뇨병PDR환자305례305안적림상자료,대기중14례14안술후발생파리체적혈적원인、표현화치료효과진행분석.결과 305례당뇨병PDR환자접수파리체절할술후발생파리체적혈자14례,발생솔위4.6％,기중3례안저병변위PDRⅣ기,4례위Ⅴ기,7례위Ⅵ기.14안균경표준첩상체절구파리체절할술,술중균급여안내격광광응,1안행공막외냉응술,8안행파리체강내규유전충.수차파리체절할술후6안시력제고,4안술후시력무개변,4안시력교술전하강.술후재차출현파리체적혈적시간위술후l ～7d자9안,술후8d～3개월자1안,술후3～6개월자2안,술후6개월이상자2안.파리체재적혈적원인주요위신생혈관막잔류、격광광응범위화강도불족、신생혈관형성급혈당농도불은정.5안약물치료후파리체적혈흡수,9안재차행파리체수술.최종9안시력제고,2안시력불변,3안시력하강;13안환안시망막복위,l안규유전충술후시망막잉미복위.결론 PDR행파리체절할술후파리체재적혈다발생우술후1주내,여시망막신생혈관잔류、안내격광광응불충분급혈당수평공제흠가유관.출혈량교소적환자파리체적혈가이자행흡수혹가행약물치료,출혈량교대차지속불흡수적환자수요재차행파리체절할술.
Background Vitrectomy is an effective method to proliferative diabetic retinopathy (PDR) in type 2 diabetic patients.Postoperative vitreous hemorrhage is a major cause of vision loss.Objective This study was to analyze the related factors of vitreous hemorrhage after vitrectomy in proliferative retinopathy with type 2 diabetes.Methods Three hundred and five eyes of 305 cases who received vitrectomy for PDR from type 2 diabetes were retrospectively investigated.The clinical data of 14 eyes with vitreous hemorrhage after vitrectomy were analyzed.Results Vitreous hemorrhage after vitrectomy occurred in 14 eyes with the incidence 4.6％.The PDR was grade ⅣV in 3 eyes,grade Ⅴ in 4 eyes and grade Ⅵ in 7 eyes.Pars plana vitrectomy with intraocular laser photocoagulation was performed on all the 14 eyes,and 1 eye accepted scleral condensation and 8 eyes accepted silicone oil tamponade.Visual acuity was improved in 6 eyes,unchanged in 4 eyes and worsen in 4 eyes after initial surgery.Vitreous hemorrhage appeared in postoperative 1-7 days in 9 eyes,8 days-3 months in 1 eye,3-6 months in 2 eyes and over 6 months in 2 eyes.The cause for postoperative vitreous hemorrhage included residual neovascular membrane,insufficient photocoagulation range and intensity,neovascularization and instable blood glucose level.Vitreous hemorrhage disappeared in 5 eyes after medicine therapy,and reoperation in 9 eyes.In the end of the follow up,visual acuity improved in 9 eyes,unchanged in 2 eyes and worsen in 3 eyes.Retinas reattached in 13 eyes.However,the retina was still detached in 1 eye with silicone oil tamponade.Conclusions Postoperative vitreous hemorrhage usually occurs within 1 week.The main related factors are residual retinal neovascular membrane,inadequate intraocular laser photocoagulation and unstable blood glucose level.Medicine therapy is effective for postoperative vitreous hemorrhage in type 2 diabetic patients,but re-vitrectomy is needed for excessive vitreous bleeding.