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目的:观察视网膜內界膜(ILM)剥离对糖尿病黄斑水肿的疗效,视力和黄斑中心凹厚度的变化以及对眼压的影响。探讨曲安奈德(TA)在玻璃体切割及ILM剥离术中的作用。方法:选取糖尿病视网膜病变(IV,V期)引起的黄斑水肿患者60例(60眼)。分成观察组和对照组各30眼。观察组行玻璃体切割手术,术中应用TA标记残留玻璃体后皮质、机化膜及ILM,剥离后极部ILM;对照组行单纯玻璃体切割手术,术中应用TA标记玻璃体后皮质及机化膜。观察:2组术前视力与术后(4个月)视力的变化以及2组之间视力的变化;2组术前、术后2周内、术后4个月眼压的变化,以及2组之间眼压的对照;术后4个月黄斑中心凹OCT值与术前对照及两组之间黄斑中心凹OCT值对照。结果:(1)视力:观察组术后4个月时视力与术前对照P<0.01,具有统计学意义;对照组术后视力与术前对照P<0.05具有统计学意义;观察组30眼中有25眼(84.6%)视力有提高,对照组30眼中有17眼(56.7%)有提高,2组之间对照P<0.05具有统计学意义。(2)黄斑中心凹OCT值:观察组术后4个月黄斑中心凹OCT值与术前对照P<0.01具有统计学意义;对照组术后黄斑中心凹OCT值与术前对照P<0.01具有统计学意义;观察组30眼中黄斑水肿消退28眼,有效率92.3%,对照组30眼中有20眼明显消退,有效率66.7%,2组之间对照P<0.05,具有统计学意义。(3)眼压:观察组术后14天内眼压与术前眼相对照P<0.05,具有统计学意义,术后4个月时眼压P>0.05,无统计学意义;对照组,术后14天内眼压与术前对照P<0.05,具有统计学意义,术后4个月眼压P>0.05,无统计学意义;术后14天内,观察组有8例眼压超过21mmHg,对照组有7例眼压超过21mmHg,2组之间对照,P>0.05无统计学意义。结论:单纯玻璃体切割手术对黄斑水肿有效,ILM剥离能明显提高手术疗效;TA的标记作用使玻璃体切割及ILM剥离更加安全确切。
OBJECTIVE: To observe the curative effect of macular edema of diabetic retinopathy (ILM) on diabetic macular edema, the change of visual acuity and foveal thickness, and the effect on intraocular pressure. To investigate the role of triamcinolone acetonide (TA) in vitrectomy and ILM dissection. Methods: 60 patients (60 eyes) with macular edema caused by diabetic retinopathy (IV, V stage) were selected. Divided into observation group and control group of 30 eyes. The observation group underwent vitrectomy. TA was used to mark the residual posterior vitreous cortex, mechanized membrane and ILM during operation, and the extremity ILM was dissected. The control group was treated by simple vitrectomy, TA was used to mark the vitreous cortex and the mechanized membrane. The changes of visual acuity and visual acuity between the two groups before and 2 weeks after surgery were observed. The changes of intraocular pressure The intraocular pressure (IOP) was compared between the two groups. The OCT of the fovea 4 months after surgery was compared with the preoperative control and the macular foveal OCT between the two groups. Results: (1) Visual acuity: Visual acuity was significantly lower in observation group than in preoperative control at 4 months postoperatively (P <0.01), and postoperative visual acuity in control group was significantly different from preoperative control (P <0.05) There were 25 eyes (84.6%) with visual acuity improved, while 17 eyes (56.7%) in 30 eyes of control group had an increase. There was significant difference between two groups (P <0.05). (2) OCT of macular fovea: OCT of macular fovea 4 months postoperatively was statistically significant compared with preoperative control (P <0.01); ocular foveal OCT of control group was Statistical analysis showed that in the observation group, macular edema disappeared in 28 eyes in 30 eyes, the effective rate was 92.3%. In 30 eyes of the control group, 20 eyes subsided obviously with an effective rate of 66.7%. There was significant difference between two groups (P <0.05). (3) intraocular pressure: intraocular pressure in the observation group within 14 days after surgery compared with the preoperative eye P <0.05, with statistical significance, IOP at 4 months after operation, P> 0.05, no significant difference; control group, surgery Intraocular pressure within 14 days after operation and preoperative control P <0.05, with statistical significance, intraocular pressure 4 months after operation, P> 0.05, no statistical significance; intraoperative 14 days, the observation group had 8 cases of intraocular pressure over 21mmHg, control Group 7 cases of intraocular pressure over 21mmHg, between the two groups control, P> 0.05 was not statistically significant. Conclusion: Simple vitrectomy is effective for macular edema. ILM exfoliation can significantly improve the curative effect. TA labeling can make vitrectomy and ILM exfoliation safer and more accurate.