Neely K A, Scroggs M W, McCuen B W
Department of Ophthalmology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA.
Am J Ophthalmol. 1998 Jul;126(1):82-90. doi: 10.1016/s0002-9394(98)00066-x.
To review the anatomic and visual outcomes of a consecutive series of phakic patients with postoperative diabetic vitreous hemorrhage (PDVH) who underwent revision vitrectomy with peripheral retinal cryotherapy.
We performed a retrospective chart review of consecutive phakic patients who underwent revision vitrectomy for PDVH who also received peripheral retinal cryotherapy. Final corrected visual acuities after revision vitrectomy with peripheral retinal cryotherapy were compared to corrected visual acuities before and at the time of PDVH. Anatomic outcomes such as retinal attachment, vitreous hemorrhage, iris neovascularization, lens opacity, and anterior hyaloidal neovascularization were considered.
Nineteen (86%) of 22 eyes (21 patients) that underwent revision of vitrectomy and transscleral peripheral retinal cryotherapy for PDVH also received supplementary endolaser photocoagulation in the posterior pole. In 16 eyes (73%), no further vitreous hemorrhaging occurred after this procedure. In six eyes (27%), vitreous hemorrhage recurred after revision of vitrectomy and peripheral retinal cryotherapy but cleared spontaneously in three of these eyes. Of the three eyes with nonclearing recurrent vitreous hemorrhage after revision of vitrectomy and peripheral retinal cryotherapy, the cause for the vitreous hemorrhage was known for two: severe, progressive anterior hyaloidal neovascularization. With a mean follow-up +/- SD of 6.8 +/- 5.1 months (range, 0.5 to 19.5 months), final corrected visual acuity after revision of vitrectomy and peripheral retinal cryotherapy for PDVH improved over preoperative visual acuity (at which time vitreous hemorrhage was present) in 18 eyes (82%) because of removal of vitreous hemorrhage from the visual axis. However, final visual acuity reached or exceeded pre-PDVH visual acuity in only five of the 15 eyes for which pre-PDVH visual acuity was known.
For phakic eyes with nonclearing PDVH, peripheral retinal cryotherapy (often augmented, when possible, by additional posterior pole endolaser photocoagulation) may be used to supplement previous retinal ablative therapy during revision of vitrectomy. This procedure leads to anatomic stabilization and visual improvement in the majority of eyes. Transscleral peripheral retinal cryotherapy is often feasible in situations (such as media opacity) that preclude use of peripheral retinal endolaser or indirect laser photocoagulation.
回顾一系列连续性有晶状体眼术后糖尿病性玻璃体出血（PDVH）患者接受玻璃体切除术联合周边视网膜冷冻疗法后的解剖和视力结果。
我们对接受PDVH玻璃体切除术联合周边视网膜冷冻疗法的连续性有晶状体眼患者进行了回顾性病历分析。将玻璃体切除术联合周边视网膜冷冻疗法后的最终矫正视力与PDVH之前及当时的矫正视力进行比较。评估视网膜附着、玻璃体出血、虹膜新生血管、晶状体混浊和前玻璃体膜新生血管等解剖学结果。
22只眼（21例患者）接受了PDVH玻璃体切除术联合经巩膜周边视网膜冷冻疗法，其中19只眼（86%）还在后极部接受了补充性视网膜内激光光凝。16只眼（73%）在此手术后未再发生玻璃体出血。6只眼（27%）在玻璃体切除术联合周边视网膜冷冻疗法后玻璃体出血复发，但其中3只眼自行吸收。在玻璃体切除术联合周边视网膜冷冻疗法后复发性玻璃体出血未吸收的3只眼中，已知2只眼玻璃体出血的原因：严重、进行性的前玻璃体膜新生血管。平均随访时间±标准差为6.8±5.1个月（范围0.5至19.5个月），由于清除了视轴内的玻璃体出血，18只眼（82%）在接受PDVH玻璃体切除术联合周边视网膜冷冻疗法后的最终矫正视力较术前（当时存在玻璃体出血）有所提高。然而，在已知PDVH术前视力的15只眼中，只有5只眼的最终视力达到或超过了PDVH术前视力。
对于非清除性PDVH的有晶状体眼，在玻璃体切除术翻修时，周边视网膜冷冻疗法（尽可能辅以额外的后极部视网膜内激光光凝）可用于补充先前的视网膜消融治疗。该手术可使大多数眼实现解剖学稳定和视力改善。经巩膜周边视网膜冷冻疗法在诸如介质混浊等妨碍使用周边视网膜内激光或间接激光光凝的情况下通常是可行的。
