慢性肾病患者严重玻璃体视网膜病变的玻璃体切除术临床分析

A clinical analysis of vitrectomy for severe vitreoretinopathy in patients with chronic renal.

作者信息

Su Long, Huang Guannan, Yin Songtao, Hua Xia, Tang Xin

机构信息

Department of Ophthalmology, The 2nd Hospital of Tianjin Medical University, Tianjin Institute of orbital Disease, Tianjin, China.

Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Vision Science Clinical College of Ophthalmology, Tianjin Medical University , No. 4 Gansu Rd, Heping District, Tianjin, 300020, China.

出版信息

BMC Ophthalmol. 2018 Feb 8;18(1):34. doi: 10.1186/s12886-018-0704-7.

DOI:10.1186/s12886-018-0704-7

PMID:29422012

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5806368/

Abstract

BACKGROUND

The recent advancement in the management of chronic renal failure (CRF) has significantly increased the longevity of the patients, which increase the incidence of severe vitreoretinopathy. The vitrectomy is highly risky in this particular group of patients due to their systemic comorbidity. The timing surgical intervention is usually delayed because of the systemic conditions. This study is to evaluate the safety and effectiveness of 25-guage vitrectomy for severe vitreoretinopathy in the CRF patients.

METHODS

In this retrospective study, 16 eyes of 16 CRF patients with severe vitreoretinopathy were undergone 25-guage vitrectomy in the department of Ophthalmology of the Second Hospital of Tianjin Medical University from February 2015 to April 2017. The visual outcome, complications and perioperative medical management were documented and analyzed.

RESULTS

The best-corrected visual acuity(BCVA)of fourteen eyes were lower than 20/200 preoperatively. Surgery duration ranged from 28 to 72 min, with a mean of 48.4 ± 13.6 min. During the surgery, 12 eyes were diagnosed with DR, while two them were complicated with tractional retinal detachment and one with branch retinal vein occlusion. Three eyes were diagnosed with branch retinal vein occlusion, and one eye was diagnosed with hypertensive retinopathy. Postoperative BCVA of six eyes ≥20/40, seven eyes ≥20/200, and three eyes < 20/200. BCVA of eight eyes improved more than three lines, three eyes improved two lines, and four eyes improved one line. BCVA decreased from hand movement to light perception in one patient who developed neovascular glaucoma two weeks after surgery.

CONCLUSION

In chronic renal failure patients with severe vitreoretinopathy, the well-planned minimally invasive vitrectomy is effective and safe. Additionally, careful management of the perioperative systemic conditions is important to improve the visual acuity and quality of life as well.

摘要

背景

慢性肾衰竭（CRF）治疗的最新进展显著延长了患者的寿命，这增加了严重玻璃体视网膜病变的发生率。由于这类患者存在全身合并症，玻璃体切除术在这一特定患者群体中风险极高。由于全身状况，手术干预的时机通常会延迟。本研究旨在评估25G玻璃体切除术治疗CRF患者严重玻璃体视网膜病变的安全性和有效性。

方法

在这项回顾性研究中，2015年2月至2017年4月期间，天津医科大学第二医院眼科对16例患有严重玻璃体视网膜病变的CRF患者的16只眼进行了25G玻璃体切除术。记录并分析视力结果、并发症及围手术期的医疗管理情况。

结果

术前14只眼的最佳矫正视力（BCVA）低于20/200。手术时间为28至72分钟，平均为48.4±13.6分钟。手术期间，12只眼被诊断为糖尿病视网膜病变（DR），其中2只合并牵引性视网膜脱离，1只合并视网膜分支静脉阻塞。3只眼被诊断为视网膜分支静脉阻塞，1只眼被诊断为高血压性视网膜病变。术后6只眼的BCVA≥20/40，7只眼≥20/200，3只眼<20/200。8只眼的BCVA提高了超过3行，3只眼提高了2行，4只眼提高了1行。1例患者术后两周发生新生血管性青光眼，BCVA从手动视力下降至光感。