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目的探讨应用免光导玻璃体手术和传统玻璃体手术治疗伴有广泛纤维血管增殖的严重增生性糖尿病视网膜病变(PDR)的效果。方法对18例(22只眼)伴有广泛纤维血管增殖预计手术操作较复杂的PDR患者,采用免光导玻璃体手术联合剥膜、视网膜复位、光凝等附加术式,术中双手操作;再由同一术者在相近时间段,采用传统玻璃体手术治疗20例(22只眼)伴有广泛纤维血管增殖的PDR患者作为对照。结果两种方式的玻璃体手术过程均顺利。但免光导玻璃体手术中,有晶状体眼在气液交换时眼底无法窥人,需回归到传统玻璃体手术的眼内照明方式。两种手术方式的患者视网膜均能完全复位,术后视力改善率分别为86．4％和77．3％,两者间差异无统计学意义(P>0．05);两种手术方式的并发症均较少,其发生率差异也无统计学意义(P>0．05);免光导玻璃体手术中平均剥膜时间比传统玻璃体手术时间短,两者间差异有统计学意义(P<0．05)。结论两种方式的玻璃体手术对严重PDR均有较好的疗效。免光导玻璃体手术剥膜的安全性较高,尤其在剥膜、电凝止血及周边部操作等方面,免光导玻璃体手术采用双手操作方式的效率较高。
Objective To investigate the efficacy of photoradiography and conventional vitrectomy in the treatment of severe proliferative diabetic retinopathy (PDR) with extensive fibrovascular proliferation. Methods 18 cases (22 eyes) with extensive fibrovascular proliferation is expected to more complicated operation of PDR patients with photoplethysmography combined with stripping, retinal reattachment, photocoagulation and other additional procedures, both hands operation; by The same surgeon used conventional vitrectomy in 20 patients (22 eyes) with extensive fibrovascular proliferation in similar time periods as a control. Results Both methods of vitreous surgery were smooth. However, in photorefractive vitrectomy, the phakic eye can not glimpse the fundus when gas-liquid exchange, and it is necessary to return to the intraocular illumination mode of traditional vitreous surgery. The retina of patients in both operation methods could be completely reset, and the postoperative visual acuity improvement rates were 86.4% and 77.3% respectively, with no significant difference (P> 0.05). The two operation methods There were no significant differences in the incidence of complications between the two groups (P> 0.05). The mean time to stripping time in vitrectomy was shorter than that in conventional vitrectomy (P < 0.05). Conclusion Both methods of vitrectomy have a good effect on severe PDR. Photoculus vitreous surgery stripping the higher safety, especially in stripping the membrane, coagulation and peripheral operation of the Department of coagulation, vitrectomy-free vitrectomy operation with two hands more efficient.