Yang Chung-May, Su Pei-Yuang, Yeh Po-Ting, Chen Muh-Shy
Department of Ophthalmology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Can J Ophthalmol. 2008 Apr;43(2):192-8. doi: 10.3129/i08-007.
Combined rhegmatogenous and traction retinal detachment (combined detachment) is a serious complication in proliferative diabetic retinopathy. The common clinical findings and surgical results of this complication were investigated.
Forty eyes of 36 consecutive patients with combined detachment undergoing pars plana vitrectomy at a teaching hospital in a 4.5-year period were retrospectively reviewed. All cases had been followed up for at least 6 months.
Only 10 of the 40 cases had a preoperative visual acuity better than finger counting vision. Extensive proliferation with multiple, thickened, plaque-like vitreoretinal adhesions and large areas of detachment were noted in 38 cases, 19 cases showing predominantly fibrous tissue and 19 cases presenting with predominantly active fibrovascular proliferation. Two cases had minimal fibrovascular proliferation. Retinal breaks were identified in 7 eyes (17.5%) before surgery and in 33 eyes (82.5%) during surgery. Thirty-seven eyes (92.5%) achieved long-term retinal reattachment. Silicone oil was used in 23 eyes (57.5%). Visual acuity improved in 28 eyes (70%), was unchanged in 6 (15%), and became worse in 6 (15%). In 19 eyes postoperative vision was better than 20/400. Multiple regression analysis showed preoperative visual acuity as the single factor associated with postoperative visual outcome.
Combined retinal detachment in proliferative diabetic retinopathy may occur during the stage of active fibrovascular proliferation or as a late complication. It is frequently associated with tightly adherent preretinal tissue and extensive detachment. Preoperative visual acuity best predicts visual prognosis.
孔源性和牵拉性视网膜脱离合并存在（联合性视网膜脱离）是增生性糖尿病视网膜病变的一种严重并发症。对该并发症的常见临床特征及手术结果进行了研究。
回顾性分析了一家教学医院在4.5年期间连续36例接受玻璃体切割术治疗联合性视网膜脱离患者的40只眼。所有病例均随访至少6个月。
40例中仅10例术前视力优于指数视力。38例可见广泛增殖，伴有多处增厚的、斑块状玻璃体视网膜粘连及大面积脱离，其中19例以纤维组织为主，19例以活跃的纤维血管增殖为主。2例有轻微的纤维血管增殖。术前7只眼（17.5%）发现视网膜裂孔，术中33只眼（82.5%）发现视网膜裂孔。37只眼（92.5%）实现了视网膜长期复位。23只眼（57.5%）使用了硅油。28只眼（70%）视力改善，6只眼（15%）视力无变化，6只眼（15%）视力变差。19只眼术后视力优于20/400。多元回归分析显示术前视力是与术后视力结果相关的唯一因素。
增生性糖尿病视网膜病变中的联合性视网膜脱离可能发生在活跃的纤维血管增殖阶段或作为晚期并发症出现。它常与紧密粘连的视网膜前组织及广泛脱离相关。术前视力最能预测视力预后。
