Divisione Oculistica, Azienda Ospedaliera "Ospedali Riuniti di Bergamo", Largo Barozzi 1, 24100 Bergamo, Italy.
EPMA J. 2010 Mar;1(1):78-81. doi: 10.1007/s13167-010-0007-4. Epub 2010 Mar 10.
Ocular treatment of progressing proliferative diabetic retinopathy is based on retinal laser photocoagulation and pars plana vitrectomy. Improvements in instrumentation and advances in techniques and procedures have increased indications for vitrectomy. These include vitreous haemorrhage preventing laser photocoagulation, severe nonclearing vitreous haemorrhage, subhyaloid and premacular haemorrhage, tractional retinal detachment involving or threatening the macula, combined tractional and rhegmatogenous retinal detachment, progressive fibrovascular proliferation, clinically significant macular oedema and rubeosis iridis. Together with the increasing number of indications, timing for vitrectomy has also changed. The beneficial effect of early vitrectomy for these indications has been clinically shown and supported by several studies. The benefit is evident in case of type I diabetes and when the duration of the diabetes is less than 20 years. Long-term outcomes can therefore be improved when individualised treatment algorithms are applied.
增殖性糖尿病性视网膜病变的眼部治疗基于视网膜激光光凝术和玻璃体切除术。仪器设备的改进以及技术和程序的进步增加了玻璃体切除术的适应证。这些适应证包括：妨碍激光光凝术的玻璃体积血、严重不能吸收的玻璃体积血、玻璃体内和黄斑前出血、牵拉性视网膜脱离累及或威胁黄斑、合并牵拉性和孔源性视网膜脱离、进行性纤维血管增生、有临床意义的黄斑水肿和新生血管性青光眼。随着适应证数量的增加，玻璃体切除术的时机也发生了变化。几项研究已经临床证实并支持这些适应证早期玻璃体切除术的有益效果。对于 1 型糖尿病和糖尿病病程小于 20 年的患者，这种效果是明显的。因此，当应用个体化治疗方案时，可以改善长期预后。
