Improvement of visual acuity in eyes with diabetic macular edema after treatment with pars plana vitrectomy
Improvement of visual acuity in eyes with diabetic macular edema after treatment with pars plana vitrectomy
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DOI：
10.1159/000080940
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发表时间：
2004-01-01
期刊：
影响因子：
2.6
通讯作者：
Kron, M
中科院分区：
文献类型：
--
作者：
Jahn, CE;von Schütz, KT;Kron, M
背景：糖尿病黄斑水肿(DME)是糖尿病视网膜病变患者严重视力丧失的主要原因。尽管氩激光光凝黄斑(M-ALC)已被证明是有益的，但仍是如此。近年来，有研究表明，平坦部玻璃体切割术(PPV)可以改善DME的视力，阻止中心视力的下降。目的：探讨PPV治疗DME的潜在益处。患者和方法：对21例(30眼)2型糖尿病合并DME患者进行了PPV检查，年龄61~88岁，中位年龄71岁。23眼为非增殖型糖尿病视网膜病变(NPDR)，7眼为增殖型糖尿病视网膜病变(PDR)合并DME。所有病例均行玻璃体后脱离手术。如果存在视网膜前膜(23眼)，则将其摘除。13只眼(最初11只眼)内界膜(ILM)也被去除。PPV术前8只眼接受M-ALC。PPV术后有3只眼出现M-ALC。一只眼在PPV后6周出现视网膜脱离，并被排除在分析之外。在最初的治疗失败后，两只眼再次接受了PPV，并剥离了ILM。另一位患者的双眼因反复玻璃体出血而出现2次重复的PPV。中位随访时间为16个月(范围1-62个月)。结果：PPV术后黄斑变平或附着20/27眼(74%)。15/18只眼(83%)在荧光素血管造影中渗漏减少或消失。术后6个月，15/27例(56%)患者中心视力提高2~6行。在可以记录PPV前视力演变的亚组(18只眼)中，平均视力和中位视力分别从0.26+/-0.19明显下降。0.2(范围0.03-0.6)至0.12+/-0.090.1(0.02-0.4)，分别增加到0.28+/-0.23。0.2(0.03-0.8)在PPV后12个月内。结论：眼底镜和荧光素血管造影证实，PPV几乎总是导致DME减少甚至完全消失。最重要的是，中心视力经常增加，有时会在很大程度上随着患者生活质量的显著改善而增加。版权所有(C)2004 S.Karger AG，巴塞尔。
Background: Diabetic macular edema (DME) is the leading cause of severe visual loss in patients with diabetic retinopathy. This is so despite the fact that argon laser photocoagulation of the macula (M-ALC) has been shown to be beneficial. Recently, it has been suggested that pars plana vitrectomy (PPV) can lead to the resolution of DME and stop the deterioration of central visual acuity. Purpose: To explore the potential benefit of PPV for the treatment of DME. Patients and Methods: PPV was carried out in 30 eyes of 21 consecutive patients ( median age 71 years, range 61-88 years) with type II diabetes mellitus suffering from DME. 23 eyes had non-proliferative diabetic retinopathy (NPDR) and 7 eyes had proliferative diabetic retinopathy (PDR) in addition to DME. Posterior vitreous detachment had to be carried out in all cases. If epiretinal membranes were present ( 23 eyes), they were removed. In 13 eyes ( initially 11 eyes) the internal limiting membrane (ILM) was also removed. Prior to PPV 8 eyes had received M-ALC. Three eyes had M-ALC after PPV. One eye developed a retinal detachment 6 weeks after PPV and was excluded form the analysis. After an initial treatment failure two eyes underwent repeat PPV with peeling of the ILM. Both eyes of another patient had 2 repeat PPVs because of recurrent vitreous hemorrhage. Median follow-up was 16 months (range 1-62 months). Results: Following PPV the macula flattened or became attached in 20/27 (74%) eyes. 15/18 (83%) eyes showed reduction or disapearance of leakage during fluorescein-angiography. Central visual acuity increased by two to six lines in 15/27 (56%) for the whole group at 6 months after PPV. For the subgroup ( 18 eyes) for which the evolution of visual acuity prior to PPV could be documented mean and median visual acuity had decreased markedly from 0.26 +/- 0.19 resp. 0.2 (range 0.03-0.6) to 0.12 +/- 0.09 resp. 0.1 (range 0.02-0.4) during the 12 months preceding PPV and increased to 0.28 +/- 0.23 resp. 0.2 (range 0.03-0.8) during the 12 months following PPV. Conclusion: PPV almost always results in a reduction and often complete disappearance of DME as evidenced by ophthalmoscopy and fluorescein-angiography. Most importantly, central visual acuity often increases, sometimes to a very large extent with dramatic improvement in quality of life of the patients. Copyright (C) 2004 S. Karger AG, Basel.