【摘要】 目的探讨增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)合并白内障行玻璃体手术硅油填充联合超声乳化吸出术或晶状体切除术的临床疗效。方法对合并有不同程度的晶状体混浊和伴有累及后极部的牵拉性视网膜脱离或牵拉-孔源性视网膜脱离以及术中出现医源性裂孔的PDR患者共76例(86眼),在行玻璃体切除手术中,根据晶状体混浊程度,采用经睫状体平坦部切除晶状体保留前囊膜(2～3级核;46眼)作为玻璃体切除+晶状体切除术组或超声乳化手术摘出晶状体保留后囊膜(3级核以上;40眼)作为玻璃体切除+超声乳化吸出术组,一期不植入人工晶状体;完成玻璃体手术后予硅油填充。术后观察的指标包括:视力、眼压、前囊膜或后囊膜混浊情况、虹膜新生血管、虹膜粘连情况、视网膜复位情况以及二期人工晶状体植入情况。结果 2组患者的术后最佳矫正视力为0.05的为32眼、25眼,分别占69.6%和62.5%,2组间差异无统计学意义(P>0.05);术后2组出现高眼压眼分别为7眼和8眼,组间差异无统计学意义(P>0.05);2组间在各级囊膜混浊程度上比较,差异均无统计学意义(均为P>0.05);2组中虹膜不同程度粘连于囊膜分别为5眼和6眼,差异无统计学意义(P>0.05);超声乳化术组中发生虹膜新生血管2眼,在晶状体切除术组中为5眼,差异无统计学意义(P>0.05);视网膜复位情况以及二期人工晶状体植入情况2组比较,差异也无统计学意义(P>0.05)。结论玻璃体手术硅油填充联合超声乳化吸出术或晶状体切除术,术后酌情行二期人工晶状体植入,都是处理严重PDR合并白内障眼的较好方法。更多还原

【Abstract】 Objective To investigate the outcomes of pars plana vitrectomy combined with phacoemulsification or lensectomy in the treatment of proliferative diabetic retinopathy(PDR) with cataract.Methods Phacoemulsification or lensectomy combined with pars plana vitrectomy with silicone oil tamponade were performed in PDR patients with cataract(76 cases,86 eyes),posterior or anterior capsule was preserved without intraocular lens(IOL) implantation simultaneously.All eyes presented tractional/rhegmatogenous retinal detachment involved in posterior retina or iatrogenic holes during surgery.Based on the opacity degree of lens,46 eyes whose nuclear hardness from degree 2 to degree 3 received the anterior capsule reservation and pars plana vitrectomy combined with lensectomy as vitrectomy combined with lensectomy group,other 40 eyes whose nuclear hardness more than 3 degrees received the anterior capsule reservation and pars plana vitrectomy combined with phacoemulsification.All eyes presented tractional/rhegmatogenous retinal detachment involved in posterior retina or iatrogenic holes during surgery.The outcomes of visual acuity,intraocular pressure,and opacity of posterior or anterior capsule,new vessels or synechia of iris,retinal reattachment,and secondary IOL implantation were analyzed.Results Best corrected visual acuity of the two groups was more than 0.05 in 32 eyes(69.6%) and 25 eyes(62.5%),respectively,there was no statistical difference between two groups(P>0.05).The high intraocular pressure appeared in 7 eyes and 8 eyes of two groups,respectively,there was no statistical difference(P>0.05).There was no statistical difference in opacity of posterior or anterior capsule with different degrees between two groups(all P>0.05).The varying degrees of iris adhesions to the capsule presented in 5 eyes and 6 eyes of two groups,respectively,there was no statistical difference(P>0.05).New vessel of iris occurred in 2 eyes and 5 eyes of two groups,respectively,there was no statistical difference(P>0.05).There was no statistical difference in retinal reattachment,re-vitrectomy and secondary IOL implantation between two groups(P>0.05).Conclusion Pars plana vitrectomy combined with phacoemulsification or lensectomy and selective secondary IOL implantation are better ways coequally to deal with severe PDR combined with cataract.更多还原