Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK.
Eye (Lond). 2010 Mar;24(3):441-9. doi: 10.1038/eye.2009.325. Epub 2010 Feb 5.
The late complications of proliferative diabetic retinopathy (PDR) comprise vitreous haemorrhage, tractional retinal detachment, combined tractional-rhegmatogenous retinal detachment, and severe fibrovascular proliferation (including macular distortion or dragging, tractional macular oedema, and media opacity due to fibrovascular tissue). This article will review the indications, techniques, and outcomes of vitrectomy surgery to treat these conditions. A careful assessment of the surgical anatomy, with particular attention to the configuration of vitreoretinal attachments, is important when determining the precise surgical procedure required. The surgical outcome after diabetic vitrectomy has steadily improved with advances in vitreoretinal surgical instrumentation and technique. Significant post-operative complications may, however, occur including cataract formation, recurrent vitreous cavity haemorrhage (early or delayed), rhegmatogenous retinal detachment, and neovascular glaucoma. Most patients will regain or retain useful vision after diabetic vitrectomy, although the visual outcome does remain unpredictable. The development of adjunctive pharmacotherapy should enable further improvements in visual outcome in the future.
增殖性糖尿病性视网膜病变（PDR）的晚期并发症包括玻璃体积血、牵引性视网膜脱离、牵拉性-裂孔源性视网膜脱离以及严重的纤维血管增生（包括黄斑扭曲或牵拉、牵引性黄斑水肿和纤维血管组织引起的介质混浊）。本文将回顾玻璃体切除术治疗这些疾病的适应证、技术和结果。在确定所需的确切手术程序时，仔细评估手术解剖结构，特别注意玻璃体视网膜附着的形态非常重要。随着玻璃体视网膜手术器械和技术的进步，糖尿病玻璃体切除术的手术结果稳步改善。然而，可能会发生显著的术后并发症，包括白内障形成、玻璃体积血（早期或延迟）复发、孔源性视网膜脱离和新生血管性青光眼。大多数患者在接受糖尿病玻璃体切除术后会恢复或保留有用的视力，尽管视力结果仍然不可预测。辅助药物治疗的发展应该能够在未来进一步改善视力结果。
