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目的:观察玻璃体手术治疗糖尿病黄斑水肿(DME)术后1a的疗效。方法:对89例(116眼)糖尿病黄斑水肿患者行玻璃体手术,观察手术前、后患者的视力、黄斑水肿改善程度以及手术并发症的情况。随访时间为1a。结果:随诊1a,术后最佳矫正视力(0.428±0.387〔mean±SD〕)与术前最佳矫正视力(0.285±0.249)比较,差异有非常显著意义(P<0.0001);41只非增殖性糖尿病视网膜病变眼中,术后最佳矫正视力(0.450±0.410)与术前最佳矫正视力(0.291±0.201)比较,差异有显著意义(P=0.0171);75只增殖性糖尿病视网膜病变眼中,术后最佳矫正视力(0.416±0.376)与术前最佳矫正视力(0.282±0.272)比较,差异有非常显著意义(P<0.0001);糖尿病视网膜病变分期对最终视力并无影响。术后,74眼黄斑水肿吸收,占63.8%。随诊中,53眼最佳矫正视力提高2行或2行以上,占45.7%;39眼视力不变,占33.6%;24眼视力下降2行或2行以上,占20.7%。术中及术后并发症包括,医源性视网膜裂孔,玻璃体积血,新生血管性青光眼,黄斑中心凹硬性渗出,黄斑萎缩及黄斑上膜。这些并发症中造成最佳矫正视力下降2行或2行以上的原因是新生血管性青光眼(4眼),黄斑萎缩(10眼),硬性渗出(9眼)及黄斑上膜(1眼)。结论:玻璃体手术可以有效提高糖尿病黄斑水肿患者的视力及改善黄斑水肿,但此治疗有着严重的并发症,因而应仔细认真行术前术后检查,掌握手术技巧。
Objective: To observe the effect of vitrectomy on diabetic macular edema (DME) after operation 1a. Methods: Eighty-nine patients (116 eyes) with diabetic macular edema underwent vitrectomy. The visual acuity, the improvement of macular edema and the complication of the operation before and after operation were observed. Follow-up time was 1a. Results: There was significant difference between the best corrected visual acuity (0.428 ± 0.387 [mean ± SD]) and the best corrected visual acuity (0.285 ± 0.249, P <0.0001) In the eyes of proliferative diabetic retinopathy, the best corrected visual acuity (0.450 ± 0.410) and the best corrected visual acuity (0.291 ± 0.201) after surgery were significantly different (P = 0.0171); in the eyes of 75 proliferative diabetic retinopathy (0.416 ± 0.376) and postoperative best corrected visual acuity (0.282 ± 0.272), the difference was significant (P <0.0001). The diabetic retinopathy stage had no effect on the final visual acuity. After surgery, 74 macular edema absorbed, accounting for 63.8%. 53 cases of best corrected visual acuity increased by 2 lines or more than 2 lines, accounting for 45.7%; 39 eyes unchanged, accounting for 33.6%; 24 eyes decreased 2 lines or more than 2 lines, accounting for 20.7%. Intraoperative and postoperative complications include iatrogenic retinal tears, vitreous hemorrhage, neovascular glaucoma, sagittal exudate of the macula, macular atrophy and macular dementia. Among the complications, the best corrected visual acuity decreased by 2 or more lines was due to neovascular glaucoma (4 eyes), macular atrophy (10 eyes), hard exudate (9 eyes) and macular membrane (1 eye) . Conclusion: Vitreous surgery can improve visual acuity and improve macular edema in patients with diabetic macular edema. However, this treatment has serious complications. Therefore, we should carefully and preoperatively check the operation and master the operative skills.