Han D P, Pulido J S, Mieler W F, Johnson M W
Eye Institute, Medical College of Wisconsis, Milwaukee, USA.
Am J Ophthalmol. 1995 May;119(5):563-70. doi: 10.1016/s0002-9394(14)70213-2.
We studied the surgical treatment and visual outcome in a consecutive series of eyes with an unusual syndrome of diabetic retinopathy and severe peripheral fibrovascular proliferation involving the equatorial and pre-equatorial fundus.
In a retrospective study of 276 eyes (245 patients) that underwent pars plana vitrectomy for diabetic retinopathy between November 1988 and February 1993, nine eyes of eight patients (3.3% of eyes and 3.3% of patients) had severe equatorial fibrovascular proliferation. The condition occurred primarily in previously unoperated-on eyes (except for panretinal photocoagulation) and resulted in peripheral traction or traction-rhegmatogenous retinal detachment (six eyes), severe vitreous hemorrhage (two eyes), and severe hypotony (one eye). Relief of traction from peripheral fibrovascular membranes was obtained with an encircling scleral buckle (nine eyes) and limited delamination and segmentation (five eyes) or relaxing retinectomy (two eyes). Lensectomy was required for adequate membrane dissection in three eyes.
After follow-up of six to 52 months (mean, 20.4 months), the visual acuity was 20/200 or better in seven of nine eyes, with complete retinal attachment in seven of nine eyes and postequatorial attachment in all eyes (100%). Poor outcome resulted from a persistent response resembling Coats' disease in one eye and preexistent long-standing retinal detachment in one eye.
Vitrectomy for severe equatorial fibrovascular proliferation differs from conventional approaches to diabetic retinopathy in that relief of retinal traction must be attained by scleral buckling and adequate dissection of peripheral fibrovascular tissue. In advanced cases, lensectomy and relaxing retinotomy may be required.
我们对一系列患有不寻常糖尿病视网膜病变综合征且赤道部和赤道前眼底出现严重周边纤维血管增生的眼睛进行了手术治疗及视力转归的研究。
在一项对1988年11月至1993年2月期间因糖尿病视网膜病变接受玻璃体切割术的276只眼（245例患者）的回顾性研究中，8例患者的9只眼（占所有眼睛的3.3%及所有患者的3.3%）出现了严重的赤道部纤维血管增生。这种情况主要发生在先前未接受过手术（除全视网膜光凝外）的眼睛中，导致周边牵拉或牵拉性 -孔源性视网膜脱离（6只眼）、严重玻璃体积血（2只眼）和严重低眼压（1只眼）。通过环扎巩膜扣带术（9只眼）、有限的分层和分割术（5只眼）或松解性视网膜切除术（2只眼）解除了周边纤维血管膜的牵拉。3只眼需要进行晶状体切除术以充分进行膜剥离。
经过6至52个月（平均20.4个月）的随访，9只眼中7只眼的视力达到20/200或更好，9只眼中7只眼视网膜完全复位，所有眼睛（100%）赤道后复位。1只眼因持续出现类似Coats病的反应，另1只眼因术前存在长期视网膜脱离导致预后不佳。
针对严重赤道部纤维血管增生的玻璃体切割术与传统的糖尿病视网膜病变治疗方法不同，因为必须通过巩膜扣带术和充分剥离周边纤维血管组织来解除视网膜牵拉。在晚期病例中可能需要进行晶状体切除术和松解性视网膜切开术。
