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目的探讨增殖期糖尿病视网膜病变(PDR)伴牵拉性视网膜脱离的患者新生血管膜分布及粘连特点。方法本研究收集2015年11月-2017年01月于安徽省立医院眼科住院诊断增殖期糖尿病视网膜病变(PDR)合并牵拉性视网膜脱离明确的54例54只眼。于玻切手术术中,根据视盘部是否覆盖新生血管膜、临床分区、象限分区三个指标分别记录新生血管膜位置。记录新生血管膜面积、新生血管膜在视盘部及眼底象限分区有无粘连。记录随访至术后6个月的术眼的最佳矫正视力(BCVA)及网膜复位情况。结果视盘部新生血管膜发病率约为72.2%。按照临床分区,新生血管膜的分布为后极部分布较多,占70.4%。按照象限分区,新生血管膜在鼻上方、鼻下方分布较多,分别为57.4%和55.6%。在合并有视盘部新生血管膜39例39眼中,与视盘部有粘连占30.8%。新生血管膜粘连在鼻上方及鼻下方较多,分别为55.6%和50.0%。随访至术后6个月,术后平均BCVA较术前平均BCVA提高,差异具有统计学意义(Z=-5.470,P<0.05)。视网膜复位率是87.0%。结论糖尿病视网膜病变(DR)患者中,合并视盘部新生血管膜发病率高。新生血管膜大部分集中在视网膜后部眼底及鼻侧。新生血管膜主要在鼻侧、视盘部粘连较多且牢固,粘连一般位于视网膜血管处。玻切手术可以改善患者的视力预后,网膜复位率也可以达到87.0%。
Objective To investigate the characteristics of neovascular membrane distribution and adhesion in patients with proliferative diabetic retinopathy (PDR) with retinal detachment. Methods This study collected from November 2015 to January 2017 in 54 eyes of 54 patients with proliferative diabetic retinopathy (PDR) complicated with traumatic retinal detachment diagnosed in Department of Ophthalmology, Anhui Provincial Hospital. During the operation of vitrectomy, the location of neovascular membrane was recorded according to whether the optic disc covered the neovascular membrane, clinical zone or quadrant zone. Record neovascular membrane area, neovascular membrane in the optic disc and fundus quadrant with or without adhesions. The best corrected visual acuity (BCVA) and omentum reattachment were recorded during the follow-up to 6 months postoperatively. Results The incidence of optic disc neovascularization was about 72.2%. According to the clinical zoning, the distribution of neovascular membrane is more posterior pole cloth, accounting for 70.4%. In accordance with the quadrant zoning, neovascular membrane in the top of the nose, nasal distribution more, respectively, 57.4% and 55.6%. In 39 cases with 39 cases of optic disc neovascularization, there was 30.8% with optic disc adhesion. Neovascular membrane adhesions in the nose and nose below more, respectively, 55.6% and 50.0%. After 6 months of follow-up, the mean BCVA after operation was significantly higher than that of preoperative BCVA (Z = -5.470, P <0.05). Retinal reattachment rate was 87.0%. Conclusion In patients with diabetic retinopathy (DR), the incidence of neovascular membrane in the optic disc is high. Most of the neovascular membrane in the retina behind the fundus and the nose. Neovascular membrane mainly in the nasal, optic disc adhesion more and firm, adhesions are generally located in the retinal blood vessels. Glass cut surgery can improve the prognosis of patients with vision, retinal reattachment rate can reach 87.0%.