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目的研究玻璃体手术治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)后采用不同眼内填充物的效果。方法对451例(536眼)行玻璃体手术治疗的PDR连续性病例从视力预后、视网膜复位、虹膜新生血管的发生、白内障形成、玻璃体再出血的角度进行回顾性分析。结果主要依据术前或术中是否出现视网膜裂孔来选择眼内填充物,总的视网膜在位率92.54%;保留灌注液患者显示出更好的视力提高率(76.24%)和视网膜复位率(92.00%),低的虹膜新生血管发生率(2.78%)和白内障发生率(8.11%),保留灌注液和填充其他填充物总视网膜复位率无统计学差异(P=0.055),保留灌注液、填充气体、填充硅油的术后玻璃体再出血均以少量为主,以填充气体组的再出血率最低(10.14%)。结论术前或术中是否合并视网膜裂孔是PDR病例玻璃体手术选择眼内填充物的重要因素,PDRⅥ期并不是选择眼内填充物的指征,提高手术技巧、减少术中医源性裂孔形成可以减少硅油或气体的使用,以避免二次手术硅油取出和并发症发生。
Objective To investigate the effect of different intraocular fillings after vitreoretinal surgery for proliferative diabetic retinopathy (PDR). Methods A retrospective analysis of 451 cases (536 eyes) with continuous PDR treated with vitrectomy was performed retrospectively from the perspectives of visual acuity, retinal reattachment, iris neovascularization, cataract formation and vitreous hemorrhage. The results mainly based on preoperative or intraoperative retinal breaks to choose intraocular filling, the total retinal reattachment rate was 92.54%; retention perfusion fluid patients showed better vision improvement rate (76.24%) and retinal reattachment rate (92.00 %), Low iris neovascularization rate (2.78%) and cataract incidence (8.11%). There was no significant difference (P = 0.055) in the total retinal reperfusion rate between preserving perfusate and filling other infusions, Gas, silicone oil filled with postoperative vitreous hemorrhage were mainly small amount, to fill the gas group, the lowest rate of rebleeding (10.14%). Conclusions Whether or not retinal breaks are preoperatively or intraoperatively is an important factor in the selection of intraocular material for vitreous surgery in patients with PDR. PDR Ⅵ is not an indication of choice of intraocular filling. Improving surgical skills and reducing intraoperative iatrogenic hiatus may reduce Use of silicone oil or gas to prevent secondary surgical silicone removal and complications.