Helbig H, Kellner U, Bornfeld N, Foerster M H
Augenklinik, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.
Klin Monbl Augenheilkd. 1998 May;212(5):339-42.
Functional results, risk factors and complications of vitrectomy for diabetic retinopathy were studied to improve our estimation for benefits and risks of vitreous surgery with current techniques.
The course of 389 consecutive eyes, who had undergone vitreous surgery for complications of diabetic retinopathy within a four year period, was retrospectively reviewed. The minimum follow-up was 6 months, the median 26 months. Risk factors were studied using multivariate logistic regression analysis.
Six months postoperatively 25% of the eyes had a visual acuity of 20/60 or better, a vision of less than 5/200 was found in 25% of the eyes. The most important risk factors were detachment of the macula and iris rubeosis. Only 16% of the eyes with tractional detachment of the macula had a postoperative vision of 20/200 or better, although in 86% the macula was anatomically successfully reattached. Postoperative retinal detachment was observed in 18% of all eyes. The incidence of this serious complication was only 5% after surgery for vitreous hemorrhage, but 54% after vitrectomy for tractional detachment of the macula.
In eyes with advanced stages of long-standing tractional detachment of the macula, the functional prognosis is very poor due to the underlying microvascular disease. In less advanced stages with vitreous hemorrhage and flat retina the risk of vitreous surgery is low.
研究糖尿病性视网膜病变玻璃体切除术的功能结果、危险因素及并发症，以改进我们对当前技术下玻璃体手术利弊的评估。
回顾性分析连续389只眼在4年内因糖尿病性视网膜病变并发症接受玻璃体手术的病程。最短随访时间为6个月，中位随访时间为26个月。采用多因素逻辑回归分析研究危险因素。
术后6个月，25%的患眼视力达到20/60或更好，25%的患眼视力低于5/200。最重要的危险因素是黄斑脱离和虹膜红变。黄斑牵拉性脱离的患眼中，只有16%术后视力达到20/200或更好，尽管86%的黄斑在解剖学上成功复位。所有患眼中18%发生术后视网膜脱离。这种严重并发症在玻璃体出血手术后的发生率仅为5%，但在黄斑牵拉性脱离玻璃体切除术后为54%。
对于长期存在的黄斑牵拉性脱离晚期的患眼，由于潜在的微血管疾病，功能预后很差。在玻璃体出血且视网膜平伏的不太晚期阶段，玻璃体手术风险较低。
