Hoerle Steffen, Poestgens Harald, Schmidt Joerg, Kroll Peter
Department of Ophthalmology, Philipps University Marburg, Robert-Koch-Strasse 4, 35033 Marburg, Germany.
Graefes Arch Clin Exp Ophthalmol. 2002 Mar;240(3):197-201. doi: 10.1007/s00417-002-0432-8. Epub 2002 Feb 21.
Vitrectomy is the treatment of choice for proliferative diabetic vitreoretinopathy with tractions and persistent vitreous hemorrhage. Since vitrectomy has recently been discussed as a possible therapy for diabetic maculopathy as well, we were especially interested in studying the change in diabetic maculopathy following surgery. For that purpose a grading system developed at our clinic was used.
In a retrospective study we evaluated fundus photographs and fluorescein angiograms of 33 eyes of 30 patients who had undergone vitrectomy for proliferative diabetic vitreoretinopathy at our clinic between 1990 and 1997. In all eyes diabetic maculopathy was present at the time of surgery. The grading was performed using preoperative images and images taken a median of 18 months postoperatively.
Best corrected visual acuity increased by 3.7 lines on average. Intraretinal dot and spot hemorrhages, hard exudates, microaneurysms on fundus photos, and leakage and cysts on fluorescein angiograms decreased after surgery. The extent of the foveolar avascular zone and the extent of the perifoveolar ischemic area worsened, however.
Vitrectomy seems to help diabetic eyes not only by removal of membranes, tractions, and vitreous hemorrhage; it seems to have a positive influence on the course of diabetic maculopathy as well. We suspect that the removal of the posterior vitreous membrane is one of the crucial factors in interrupting the disease process. From these results the indication for vitrectomy in diabetic patients may have to be reconsidered and extended to include diabetic maculopathy prior to the development of ischemia.
玻璃体切除术是治疗伴有牵拉和持续性玻璃体出血的增生性糖尿病性玻璃体视网膜病变的首选方法。由于最近也讨论了玻璃体切除术作为糖尿病性黄斑病变的一种可能治疗方法，我们特别感兴趣研究手术后糖尿病性黄斑病变的变化。为此，我们使用了在我们诊所开发的一种分级系统。
在一项回顾性研究中，我们评估了1990年至1997年间在我们诊所接受增生性糖尿病性玻璃体视网膜病变玻璃体切除术的30例患者的33只眼睛的眼底照片和荧光素血管造影。所有眼睛在手术时均存在糖尿病性黄斑病变。分级使用术前图像和术后中位数18个月拍摄的图像进行。
最佳矫正视力平均提高了3.7行。视网膜内点状和斑状出血、硬性渗出、眼底照片上的微动脉瘤以及荧光素血管造影上的渗漏和囊肿在手术后减少。然而，黄斑无血管区的范围和黄斑周围缺血区的范围恶化。
玻璃体切除术似乎不仅通过去除膜、牵拉和玻璃体出血来帮助糖尿病患者的眼睛；它似乎对糖尿病性黄斑病变的病程也有积极影响。我们怀疑去除玻璃体后皮质是中断疾病进程的关键因素之一。根据这些结果，糖尿病患者玻璃体切除术的适应症可能需要重新考虑并扩大到包括在缺血发生之前的糖尿病性黄斑病变。
