Jahn Claus E, Töpfner von Schutz Kerstin, Richter Joachim, Boller Jürgen, Kron Martina
Augenpraxisklinik Dr. Jahn, Kempten, Deutschland.
Ophthalmologica. 2004 Nov-Dec;218(6):378-84. doi: 10.1159/000080940.
Diabetic macular edema (DME) is the leading cause of severe visual loss in patients with diabetic retinopathy. This is so despite the fact that argon laser photocoagulation of the macula (M-ALC) has been shown to be beneficial. Recently, it has been suggested that pars plana vitrectomy (PPV) can lead to the resolution of DME and stop the deterioration of central visual acuity.
To explore the potential benefit of PPV for the treatment of DME.
PPV was carried out in 30 eyes of 21 consecutive patients (median age 71 years, range 61-88 years) with type II diabetes mellitus suffering from DME. 23 eyes had non-proliferative diabetic retinopathy (NPDR) and 7 eyes had proliferative diabetic retinopathy (PDR) in addition to DME. Posterior vitreous detachment had to be carried out in all cases. If epiretinal membranes were present (23 eyes), they were removed. In 13 eyes (initially 11 eyes) the internal limiting membrane (ILM) was also removed. Prior to PPV 8 eyes had received M-ALC. Three eyes had M-ALC after PPV. One eye developed a retinal detachment 6 weeks after PPV and was excluded form the analysis. After an initial treatment failure two eyes underwent repeat PPV with peeling of the ILM. Both eyes of another patient had 2 repeat PPVs because of recurrent vitreous hemorrhage. Median follow-up was 16 months (range 1-62 months).
Following PPV the macula flattened or became attached in 20/27 (74%) eyes. 15/18 (83%) eyes showed reduction or disappearance of leakage during fluorescein-angiography. Central visual acuity increased by two to six lines in 15/27 (56%) for the whole group at 6 months after PPV. For the subgroup (18 eyes) for which the evolution of visual acuity prior to PPV could be documented mean and median visual acuity had decreased markedly from 0.26 +/- 0.19 resp. 0.2 (range 0.03-0.6) to 0.12 +/- 0.09 resp. 0.1 (range 0.02-0.4) during the 12 months preceding PPV and increased to 0.28 +/- 0.23 resp. 0.2 (range 0.03-0.8) during the 12 months following PPV.
PPV almost always results in a reduction and often complete disappearance of DME as evidenced by ophthalmoscopy and fluorescein-angiography. Most importantly, central visual acuity often increases, sometimes to a very large extent with dramatic improvement in quality of life of the patients.
糖尿病性黄斑水肿（DME）是糖尿病视网膜病变患者严重视力丧失的主要原因。尽管黄斑区氩激光光凝术（M-ALC）已被证明有益，但情况依然如此。最近，有人提出玻璃体切除术（PPV）可使DME消退并阻止中心视力恶化。
探讨PPV治疗DME的潜在益处。
对21例连续的II型糖尿病伴DME患者的30只眼实施PPV（年龄中位数71岁，范围61-88岁）。23只眼患有非增殖性糖尿病视网膜病变（NPDR）,7只眼除DME外还患有增殖性糖尿病视网膜病变（PDR）。所有病例均需进行玻璃体后脱离。如果存在视网膜前膜（23只眼）则予以切除。13只眼（最初11只眼）还切除了内界膜（ILM）。PPV前8只眼接受过M-ALC。3只眼在PPV后接受了M-ALC。1只眼在PPV后6周发生视网膜脱离，被排除在分析之外。在最初治疗失败后，2只眼再次进行PPV并剥除ILM。另一名患者的双眼因反复玻璃体出血进行了2次重复PPV。随访时间中位数为16个月（范围1-62个月）。
PPV后，27只眼中20只（74%）黄斑变平或贴附。18只眼中15只（83%）在荧光素血管造影时渗漏减少或消失。PPV后6个月时，全组27只眼中15只（56%）中心视力提高了2至6行。对于PPV前视力变化情况可记录在案的亚组（18只眼）而言,PPV前12个月期间平均视力和视力中位数分别从0.26±0.19和0.2（范围0.03-0.6）显著下降至0.12±0.09和0.1（范围0.02-0.4），而PPV后12个月期间增至0.28±0.23和0.2（范围0.03-0.8）。
PPV几乎总能使DME减轻，且常常完全消失,检眼镜检查和荧光素血管造影均证实了这一点。最重要 的是，中心视力常常提高，有时提高幅度很大，患者生活质量显著改善。
