Oficjalska-Młyńczak Jolanta, Jamrozy-Witkowska Agnieszka, Muzyka-Woźniak Maria, Turno-Krecicka Anna, Gołebiowska Bozena
Katedry i Kliniki Okulistyki, Akademii Medycznej we Wrocławiu.
Klin Oczna. 2006;108(7-9):273-7.
To evaluate the efficacy of pars plana vitrectomy with retinal internal limiting membrane (ILM) peeling in eyes with diabetic macular edema.
Twenty five eyes of 25 patients with diabetic macular edema. All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling and air endotamponde. Preoperatively visual acuity (VA), funduscopic examination and the presence or absence of posterior vitreous detachment, were evaluated. Fluorescein angiography was performed in all patients prior to surgery. Eyes with cystoid macular edema or macular ischaemia were excluded. Postoperative VA, anatomic results, and complications were recorded. The follow-up was 7 to 27 months (mean 17).
Intraoperatively, thick posterior hyaloid was found to be attached to the posterior pole in 20 cases. The mean postoperative VA (0.2) was significantly better than the preoperative VA (0.08) (p = 0.0001). VA improved postoperatively in 21 eyes (84%), at least two lines on the Snellen chart in 8 eyes (32%). It remained unchanged in 4 eyes (16%). Confluent hard exudates in fovea were present significantly more frequently in eyes without VA improvement (p = 0.004). The postoperative VA was better in eyes that had not undergone photocoagulation (improvement by 0.14 line) than in others (improvement by 0.11 line) but the difference was non-significant. Reduction of macular exudates was noted in every case in the follow-up over 6 months. Postoperative complication included retinal detachment were treated by re-vitrectomy with oil endotamponade. Cataract has been noted in six eyes.
Vitrectomy including removal of ILM in diabetic macular edema, leads to improvement of visual acuity and long-term stabilization of visual function.
评估玻璃体视网膜内界膜（ILM）剥除的玻璃体切除术治疗糖尿病性黄斑水肿的疗效。
25例糖尿病性黄斑水肿患者的25只眼。所有患眼均接受了玻璃体切除术，包括后玻璃体脱离、ILM剥除及空气眼内填充。术前评估视力（VA）、眼底检查及玻璃体后脱离情况。所有患者术前均行荧光素血管造影。排除黄斑囊样水肿或黄斑缺血的患眼。记录术后VA、解剖结果及并发症。随访7至27个月（平均17个月）。
术中发现20例厚的后玻璃体附着于后极部。术后平均VA（0.2）显著优于术前VA（0.08）（p = 0.0001）。21只眼（84%）术后VA提高，8只眼（32%）在Snellen视力表上至少提高两行。4只眼（16%）保持不变。VA未改善的患眼中，黄斑区融合性硬性渗出更为常见（p = 0.004）。未接受光凝治疗的患眼术后VA改善（提高0.14行）优于其他患眼（提高0.11行），但差异无统计学意义。随访6个月以上，每例均可见黄斑渗出减少。术后并发症包括视网膜脱离，行再次玻璃体切除联合硅油眼内填充治疗。6只眼出现白内障。
玻璃体切除术联合ILM剥除治疗糖尿病性黄斑水肿可提高视力并使视功能长期稳定。
