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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2017, Vol. 07 ›› Issue (06) : 269 -274. doi: 10.3877/cma.j.issn.2095-2007.2017.06.006

所属专题： 文献；

论著

增殖性糖尿病视网膜病变行玻璃体切除术后玻璃体再积血原因及处理方法的探讨
刘卫东1, 白赫南1, 毕燃1,†(), 朱丹2   
  1. 1. 024000　赤峰，内蒙古赤峰市第二医院眼科
    2. 010050　呼和浩特，内蒙古医科大学附属医院眼科
  • 收稿日期:2017-12-20 出版日期:2017-12-28
  • 通信作者: 毕燃
  • 基金资助:
    国家自然科学基金(81560165)

The cause and treatment of vitreous rebleeding after vitrectomy for proliferative diabetic retinopathy

Weidong Liu1, Henan Bai1, Ran Bi1,†(), Dan Zhu2   

  1. 1. Department of Ophthalmology, Chifeng Second Hospital, Inner Mongolia, Chifeng 024000, China
    2. Department of Ophthalmology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
  • Received:2017-12-20 Published:2017-12-28
  • Corresponding author: Ran Bi
  • About author:
    Correspondence author: Bi Ran, Email:
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引用本文：

刘卫东, 白赫南, 毕燃, 朱丹. 增殖性糖尿病视网膜病变行玻璃体切除术后玻璃体再积血原因及处理方法的探讨[J]. 中华眼科医学杂志(电子版), 2017, 07(06): 269-274.

Weidong Liu, Henan Bai, Ran Bi, Dan Zhu. The cause and treatment of vitreous rebleeding after vitrectomy for proliferative diabetic retinopathy[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2017, 07(06): 269-274.

目的

对增殖性糖尿病视网膜病变(PDR)行玻璃体切除术后并发玻璃体再积血的原因进行研究，并探讨其相应的处理方法。

方法

选择2016年4月至2017年4月经内蒙古自治区赤峰市第二医院眼科诊断为PDR的患者30例(30只眼)的临床资料。全部患者均行玻璃体切除术，且术后均并发玻璃体再积血。对全部行玻璃体切除术治疗PDR后并发玻璃体再积血症状的患者进行分析，实施针对性治疗，并观察预后效果。针对眼压正常且未合并视网膜脱离的患者23例(23只眼)，均采用保守治疗，给予患者口服或肌注止血类药物及活血化瘀类中药等。针对视网膜脱离的患者7例(7只眼)，采用玻璃体视网膜手术进行治疗。

结果

PDR患者行玻璃体切除术后并发玻璃体再积血症状的原因主要有以下几个方面，三通道玻璃体切除术巩膜切口的内口出现新生血管10例(10只眼)，占总眼数的33.33%；残留血管膜残端出血5例(5只眼)，占总眼数的16.67%；视网膜或视盘新生血管出血8例(8只眼)，占总眼数的26.67%；视网膜静脉阻塞3例(3只眼)，占总眼数的10.00%；另有原因不明的患者4例(4只眼)，占总眼数的13.33%。不同患者行玻璃体切除术后并发玻璃体再积血的时间不同，术后一周并发14例(14只眼)，占总眼数的46.67%；硅油取出后直接并发6例(6只眼)，占总眼数的20.00%；硅油取出后1个月时并发5例(5只眼)，占总眼数的16.67%；硅油取出后3个月时并发5例(5只眼)，占总眼数的16.67%。对全部患者进行随访，治疗后6个月，在采用保守治疗的患者23例(23只眼)中，20例(20只眼)患者积血全部消失；对于经保守治疗无效的患者3例(3只眼)，需再次行玻璃体视网膜手术治疗；7例(7只眼)视网膜脱离的患者，行玻璃体视网膜手术后，积血均全部消失。

结论

PDR患者行玻璃体切除术后并发玻璃体再积血的主要原因为三通道玻璃体切除术巩膜切口的内口出现新生血管、残留血管膜残端出血、视网膜或视盘新生血管出血及视网膜静脉阻塞等四类。临床上可以根据患者的具体情况进行针对性治疗，以提高患者的预后效果。

关键词: 增殖性糖尿病视网膜病变, 玻璃体切除术, 玻璃体再积血
Objective

To study the causes of vitreous reaccumulation of blood after vitrectomy for proliferative diabetic retinopathy (PDR), and to analyze the corresponding treatment methods.

Methods

The clinical data of 30 cases (30 eyes) of PDR in the Department of Ophthalmology of Chifeng Second Hospital of Inner Mongolia from April 2016 to 2017 were selected for 4 menstruation. Vitrectomy was performed in all patients with vitreous reaccumulation of blood. All the patients with vitrectomy with vitrectomy after PDR were analyzed, and the therapeutic effect was observed and the prognosis was observed. 23 cases (23 eyes) with normal intraocular pressure and no retinal detachment were treated with conservative treatment. They were given oral or intramuscular injection of hemostatic drugs and Chinese herbs for promoting blood circulation and removing blood stasis. 7 cases (7 eyes) with retinal detachment were treated with vitreoretinal surgery.

Results

The reason for PDR patients in postoperative vitreous body hematocele and vitreous body symptoms are mainly in the following aspects, three channel resection of sclera incision in the vitreous body neovascularization occurred in 10 cases (10 eyes), the total number of eyes 33.33%; 5 cases (5 eyes) of residual membrane vascular stump hemorrhage, the total number of eyes 16.67%; retinal or optic disc neovascularization and hemorrhage in 8 cases (8 eyes), the total number of eyes 26.67%; 3 cases (3 eyes) of retinal vein occlusion, the total number of eyes 10.00%; 4 cases (4 eyes) of otherwise unexplained patients, the total number of eyes 13.33%. Time with vitreous body hematocele and different patients with vitreous body after resection, 14 cases (14 eyes) a week after surgery, the total number of eyes 46.67% after silicone oil removal; concurrent 6 cases (6 eyes), the total number of eyes 20.00% after silicone oil removal; 1 months with 5 cases (5 eyes), the total number of eyes 16.67%; 3 months after silicone oil removal with 5 cases (5 eyes), the total number of eyes 16.67%. All patients were followed up. 6 months after treatment, 23 cases (23 eyes) were conservatively treated. 20 cases (20 eyes) had no blood loss. 3 cases (3 eyes) who had no conservative treatment were required to undergo vitreoretinal surgery. In 7 cases (7 eyes) with retinal detachment, all blood disappeared after vitreoretinal surgery.

Conclusion

The main reason for PDR patients complicated with vitreous body after resection of vitreous body hematocele three channel and resection of sclera incision in vitreous body, residual neovascularization membrane vascular stump hemorrhage, retinal hemorrhage or disc neovascularization and retinal vein occlusion, clinically according to the specific circumstances of the patients for targeted treatment, in order to improve the prognosis in patients.

Key words: Proliferative diabetic retinopathy, Vitrectomy, Vitreous reaccumulation of blood
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