Meier P, Wiedemann P
University Eye Hospital, Leipzig, Germany.
Graefes Arch Clin Exp Ophthalmol. 1997 Sep;235(9):569-74. doi: 10.1007/BF00947086.
A small number of eyes with proliferative diabetic retinopathy develop massive central fibrovascular membranes characterized by vitreoretinal tractions along the arcades and optic disk and retinal traction lines extending through the macula. The aim of our study was first to present the results of vitrectomy for removal of these central membranes and second to determine the correlation between preoperative parameters and postoperative visual outcome.
We treated 28 eyes with severe central fibrovascular diabetic membranes by a modified bi-manual en bloc excision technique during vitrectomy. Preoperative examination included general status, visual acuity, slit-lamp investigation, binocular funduscopy, ultrasound investigation and visual evoked potentials (VEP). Further, we analyzed intraoperative complications and postoperative anatomic and functional outcomes.
The retinas of 27 eyes with central traction retinal detachments were reattached by surgery. With a minimum of 6 months' follow-up, the macula remained attached in 24 eyes, while the retinas were completely attached in 22 eyes. Preoperative visual acuity was defective light perception to 0.1; an increase in visual acuity to maximal 0.1 was seen in 50% of the patients postoperatively. Preoperative visual acuity of light perception was associated with no functional improvement. Preoperative ultrasound investigation gave information about the real anatomic situation of the retina, especially if funduscopy was not possible. The other preoperative parameters could not predict correctly the functional outcome of vitrectomy in diabetics with severe central fibrovascular membranes because of the damage of the optic nerve and the retina.
The high rate of anatomical reattachment after vitrectomy in diabetic eyes with severe central fibrovascular membranes is associated with a slight improvement of function; only preoperative visual acuity of hand motions or better was associated with an improvement of function.
少数增殖性糖尿病视网膜病变患者会出现巨大的中央纤维血管膜，其特征为沿视网膜血管弓和视盘的玻璃体视网膜牵拉，以及延伸穿过黄斑的视网膜牵引线。我们研究的目的首先是展示玻璃体切除术治疗这些中央膜的结果，其次是确定术前参数与术后视力结果之间的相关性。
我们在玻璃体切除术中采用改良的双手整块切除技术治疗了28只患有严重中央纤维血管性糖尿病膜的眼睛。术前检查包括一般状况、视力、裂隙灯检查、双眼眼底镜检查、超声检查和视觉诱发电位（VEP）。此外，我们分析了术中并发症以及术后的解剖和功能结果。
27只患有中央牵引性视网膜脱离的眼睛通过手术实现了视网膜复位。经过至少6个月的随访，24只眼睛的黄斑保持附着，22只眼睛的视网膜完全附着。术前视力从光感不良到0.1；术后50%的患者视力提高至最大0.1。术前光感视力的患者术后功能无改善。术前超声检查提供了视网膜真实解剖情况的信息，尤其是在无法进行眼底镜检查时。由于视神经和视网膜的损伤，其他术前参数无法正确预测患有严重中央纤维血管膜的糖尿病患者玻璃体切除术的功能结果。
患有严重中央纤维血管膜的糖尿病眼玻璃体切除术后解剖复位率高，但功能仅有轻微改善；只有术前手动视力或更好的视力与功能改善相关。
