中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2013年
2期
124-127
,共4页
狄浩浩%陈松%王昀%郑丹%方思捷
狄浩浩%陳鬆%王昀%鄭丹%方思捷
적호호%진송%왕윤%정단%방사첩
糖尿病视网膜病变%玻璃体视网膜手术%硅油取出%白内障超声乳化术%并发症
糖尿病視網膜病變%玻璃體視網膜手術%硅油取齣%白內障超聲乳化術%併髮癥
당뇨병시망막병변%파리체시망막수술%규유취출%백내장초성유화술%병발증
Diabetic retinopathy%Vitreoretinal surgery%Silicone oil removal%Cataract surgery%Complications
目的 分析Ⅵ期严重增殖型糖尿病视网膜病变(PDR)行保留晶状体的玻璃体视网膜手术(VRS)联合硅油填充术后,硅油取出时联合白内障超声乳化术的临床疗效及术后并发症.方法 回顾性系列病例研究.收集2009年1月至2011年6月在天津眼科医院就诊的72例91只眼PDR患者均行23G或20G彻底的玻璃体切除、膜剥除、曲安奈德使用、气液交换或重水使用、眼内激光、巩膜外冷冻及硅油填充,所有手术保留晶状体.根据术后眼底恢复情况择期行硅油取出联合白内障超声乳化术.记录术前术后最佳矫正视力(BCVA)及术后并发症.结果 所有患者平均年龄(54.35-±7.20)岁,术后随访12～28个月,VRS和硅油取出联合白内障手术间隔平均时间(3.7±1.3)个月,视网膜完全复位88只眼,部分复位3只眼,复位率96.7％.59只眼(64.8％)术后BCVA提高,23只眼(25.3％) BCVA保持不变,另9只眼(9.9％)BCVA下降；术后BCVA≥0.1者54只眼(59.3％),0.02～0.1者19只眼(20.9％),≤0.02者18只眼(19.8％),术后2只眼BCVA达到0.8.术后并发糖尿病视神经病变32只眼(35.2％)；视网膜前膜14只眼(15.4％)；RD再发4只眼(4.4％)；继发性青光眼4只眼(4.4％)；一过性高眼压发生9只眼(9.9％),低眼压4只眼(4.4％),玻璃体再出血3只眼(3.3％).结论 严重PDR患者保留晶状体的VRS联合硅油填充术后,行硅油取出联合白内障超声乳化术安全有效.
目的 分析Ⅵ期嚴重增殖型糖尿病視網膜病變(PDR)行保留晶狀體的玻璃體視網膜手術(VRS)聯閤硅油填充術後,硅油取齣時聯閤白內障超聲乳化術的臨床療效及術後併髮癥.方法 迴顧性繫列病例研究.收集2009年1月至2011年6月在天津眼科醫院就診的72例91隻眼PDR患者均行23G或20G徹底的玻璃體切除、膜剝除、麯安奈德使用、氣液交換或重水使用、眼內激光、鞏膜外冷凍及硅油填充,所有手術保留晶狀體.根據術後眼底恢複情況擇期行硅油取齣聯閤白內障超聲乳化術.記錄術前術後最佳矯正視力(BCVA)及術後併髮癥.結果 所有患者平均年齡(54.35-±7.20)歲,術後隨訪12～28箇月,VRS和硅油取齣聯閤白內障手術間隔平均時間(3.7±1.3)箇月,視網膜完全複位88隻眼,部分複位3隻眼,複位率96.7％.59隻眼(64.8％)術後BCVA提高,23隻眼(25.3％) BCVA保持不變,另9隻眼(9.9％)BCVA下降；術後BCVA≥0.1者54隻眼(59.3％),0.02～0.1者19隻眼(20.9％),≤0.02者18隻眼(19.8％),術後2隻眼BCVA達到0.8.術後併髮糖尿病視神經病變32隻眼(35.2％)；視網膜前膜14隻眼(15.4％)；RD再髮4隻眼(4.4％)；繼髮性青光眼4隻眼(4.4％)；一過性高眼壓髮生9隻眼(9.9％),低眼壓4隻眼(4.4％),玻璃體再齣血3隻眼(3.3％).結論 嚴重PDR患者保留晶狀體的VRS聯閤硅油填充術後,行硅油取齣聯閤白內障超聲乳化術安全有效.
목적 분석Ⅵ기엄중증식형당뇨병시망막병변(PDR)행보류정상체적파리체시망막수술(VRS)연합규유전충술후,규유취출시연합백내장초성유화술적림상료효급술후병발증.방법 회고성계렬병례연구.수집2009년1월지2011년6월재천진안과의원취진적72례91지안PDR환자균행23G혹20G철저적파리체절제、막박제、곡안내덕사용、기액교환혹중수사용、안내격광、공막외냉동급규유전충,소유수술보류정상체.근거술후안저회복정황택기행규유취출연합백내장초성유화술.기록술전술후최가교정시력(BCVA)급술후병발증.결과 소유환자평균년령(54.35-±7.20)세,술후수방12～28개월,VRS화규유취출연합백내장수술간격평균시간(3.7±1.3)개월,시망막완전복위88지안,부분복위3지안,복위솔96.7％.59지안(64.8％)술후BCVA제고,23지안(25.3％) BCVA보지불변,령9지안(9.9％)BCVA하강；술후BCVA≥0.1자54지안(59.3％),0.02～0.1자19지안(20.9％),≤0.02자18지안(19.8％),술후2지안BCVA체도0.8.술후병발당뇨병시신경병변32지안(35.2％)；시망막전막14지안(15.4％)；RD재발4지안(4.4％)；계발성청광안4지안(4.4％)；일과성고안압발생9지안(9.9％),저안압4지안(4.4％),파리체재출혈3지안(3.3％).결론 엄중PDR환자보류정상체적VRS연합규유전충술후,행규유취출연합백내장초성유화술안전유효.
Objective To evaluate long term visual outcome and complications of combination silicone oil removal with cataract surgery after vitreoretinal surgery reserved lens for severe proliferative diabetic retinopathy.Methord Retrospective series of clinical case studies about severe PDR.All 72cases 91 eyes of PDR patients were underwent 23G or 20G pars plana vitrectomy reserved lens,fibrovascular membranes peeling,triamcinolone acetonide use,fluid-air exchange or Perfluorodecalin use,interaocular laser,Sclera cryoablation and silicone oil tamponade,the lens is reserved in all eyes.When silicone oil was removed,phacoemulsification was combined at the same time.General material,preoperative and postoperative best corrected visual acuity and postoperative complications were recorded.Results The mean age of all patients was 54.35±7.20 yeas(range 39 to 70 years)and the postoperative follow-up time was 12 to 28 months.Time interval between VRS and silicone oil removal is 2.0～8.9 months,mean time 3.7±1.3 months;Anatomic retinal attachment was achieved in 88 eyes,Postoperatively,BCVA improved in 59 eyes (64.8％),remained unchanged in 23 eyes (25.3％) and declined in 9 eyes(9.9％).The postoperative complication incidence of diabetic optic neuropathy,Epiretinal membrane,recurrent RD,Secondary glaucoma,transient intraocular pressure rise,hypotony and vitreous hemorrhage was 35.2％,15.4％,4.4％,4.4％,9.9％,4.4％ and 3.3％ respectively.Conclusions In patients with silicone oil tamponade after vitrectomy reserved lens for severe proliferative diabetic retinopathy,silicone oil removal combined with phacoemulsification is safe and effective.
