Terasaki H, Miyake Y, Awaya S
Department of Ophthalmology, Nagoya University School of Medicine, Japan.
Am J Ophthalmol. 1997 Mar;123(3):370-6. doi: 10.1016/s0002-9394(14)70133-3.
To evaluate the extreme peripheral retina and pars plana during vitrectomy in patients with proliferative diabetic retinopathy.
In a prospective study using a modified ophthalmic endoscopic system and an intraocular light source, we performed fluorescein angiography during pars plana vitrectomy in 12 eyes of 10 patients with proliferative diabetic retinopathy. Vitrectomy had been performed previously in two patients, and the subsequent surgery was necessary because of recurrent vitreous hemorrhage in one patient and silicone oil removal in the other.
All 12 eyes of 10 patients demonstrated a wide avascular area in the peripheral retina anterior to the previous photocoagulation scar. At the ora serrata in two eyes, a fibrovascular ridge of peripheral retinal vessels with fluorescein leakage that resembled the demarcation line in retinopathy of prematurity was noted; one eye had developed neovascular glaucoma 4 weeks after vitrectomy with maximum augmentation of endolaser photocoagulation, and the other eye had neovascular glaucoma that had been treated with photocoagulation 1 year before vitrectomy. In the two eyes that had undergone previous pars plana vitrectomy, fluorescein leakage was apparent at the fibrous scar of the sclerotomy site.
Intraoperative fluorescein angiography using an endoscope disclosed unusual findings in the extreme peripheral retina and pars plana of patients with proliferative diabetic retinopathy. Intraoperative fluorescein angiography may aid intraoperative evaluation and treatment of proliferative diabetic retinopathy.
评估增殖性糖尿病视网膜病变患者玻璃体切除术中的极周边视网膜和平坦部。
在一项前瞻性研究中，我们使用改良的眼科内镜系统和眼内光源，对10例增殖性糖尿病视网膜病变患者的12只眼进行了平坦部玻璃体切除术中的荧光素血管造影。其中2例患者此前已接受过玻璃体切除术，1例因复发性玻璃体出血，另1例因硅油取出而需要再次手术。
10例患者的12只眼中，在先前光凝瘢痕前方的周边视网膜均显示出广泛的无血管区。在2只眼的锯齿缘处，可见周边视网膜血管的纤维血管嵴伴荧光素渗漏，类似于早产儿视网膜病变中的分界线；1只眼在玻璃体切除术后4周发生新生血管性青光眼，术中进行了最大程度的眼内激光光凝，另1只眼在玻璃体切除术前1年已接受光凝治疗新生血管性青光眼。在2只先前接受过平坦部玻璃体切除术的眼中，巩膜切口部位的纤维瘢痕处可见荧光素渗漏。
使用内镜进行术中荧光素血管造影揭示了增殖性糖尿病视网膜病变患者极周边视网膜和平坦部的异常表现。术中荧光素血管造影可能有助于增殖性糖尿病视网膜病变的术中评估和治疗。
