增殖性糖尿病视网膜病变多次手术临床分析

Clinical analysis for reoperation after vitrectomy for proliferative diabetic retinopathy

摘要:

目的：探讨增殖性糖尿病视网膜病变玻璃体切割术后多次手术的原因及处理。

方法：回顾性分析3a来因增殖性糖尿病视网膜病变行玻璃体切割术后需要再次手术的患者。

结果：患者189眼术后需要再次进行手术的为24例26眼(占总观察眼数13.8%)。分别是：玻璃体再积血3眼，前房积血1眼，视网膜脱离11眼(占总观察眼数5.8%，占再手术眼42.3%，其中3眼合并新生血管性青光眼)，白内障6眼(占总观察眼数3.2%)，单纯硅油取出5眼。189眼中有6眼发生了新生血管性青光眼(3.2%)，6眼均为玻璃体晶状体联合手术或玻璃体切割术后又摘除白内障病例。2次手术19眼，3次或以上手术7眼(其中5眼合并视网膜脱离)。

结论：发生视网膜脱离是糖尿病视网膜病变玻璃体切割术后需要多次手术的主要原因； 也占据需要3次或以上手术的主要部分。新生血管性青光眼的发生值得重视，出现视网膜脱离时要提高警惕，需要摘除晶状体时必须慎重。

Abstract:

AIM: To explore the reasons and management of reoperation after vitrectomy for proliferative diabetic retinopathy(PDR)which need more times surgery.

METHODS:The cases with PDR which need more times surgery after vitrectomy were retrospectively analyzed in 3 years.

RESULTS: Twenty-six eyes(13.8%)of 24 cases needed more times surgery in 189 eyes. Of those 26 eyes, 3 eyes had vitreous hemorrhage again, 1 eye had hyphema, 11 eyes(5.8%, 3 eyes accompanied by neovascular glaucoma)had retinal detachment which occupied 42.3% of reoperation eyes, 6 eyes(3.2%)had cataract extraction, 5 eyes had pure silicon oil removing. 6 eyes(3.2%)of 189 eyes happened neovascular glaucoma. Every glaucoma eye accompanied by cataract extraction. 19 eyes had two times surgery, 7 eyes had three or more operations(5 eyes combining with retinal detachment).

CONCLUSION:Retinal detachment is the main cause for the reoperation after vitrectomy for PDR. Three or more times surgery may be needed if retinal detachment occurred after vitrectomy. It is worth paying more attention to neovascular glaucoma. Appearing retinal detachment must be on the alert and cataract extraction must be careful.