后节联合前节手术的利与弊
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Advantages and disadvantages of combined surgery which consists of posterior segment diseases and anterior segment disease
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    摘要:

    目的:探讨在后节手术中合并前节疾病(白内障、青光眼、角膜病)联合手术的利与弊,并分析影响手术效果的危险因素。

    方法:有针对性的分为A组增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR),B组复杂性视网膜脱离(retinal detachment,RD),为了便于对比,又将A组分为A1组:单纯玻璃体切割组; A2组:玻璃体切割+白内障摘除组; A3组:玻璃体切割+白内障摘除+人工晶状体植入术组。将B组分为B1组:单纯玻璃体切割组; B2组:玻璃体切割+白内障摘除组; B3组:玻璃体切割+白内障摘除+人工晶状体植入术组。

    结果:手术的并发症为主要观察指标,A组为新生血管性青光眼,B组为手术复发或更严重的PVR形成。其并发症的发生率A3>A2>A1,A3明显高于A2和A1,均有统计学意义,A2>A1,但无统计学意义。B组三组的结果与A组三组相同。

    结论:可能的情况下尽量不选择联合手术,如影响操作则选择非一期植入人工晶状体。

    Abstract:

    AIM: To discuss the advantages and disadvantages of combined surgery, which consists of posterior segment diseases and anterior segment diseases(cataract, glaucoma, keratonosus), and analyze the hazards that may affect surgery.

    METHODS: Group A: proliferative diabetic retinopathy(PDR), group B: complicated retinal detachment(RD). For comparison, group A was divided to group A1: vitrectomy; group A2: vitrectomy + cataract extraction; group A3: vitrectomy + cataract extraction + intraocular lens implantation. Group B was divided to group B1: vitrectomy; group B2: vitrectomy + cataract extraction; group B3: vitrectomy + cataract extraction+ intraocular lens implantation.

    RESULTS: Surgery complications were the main outcome measures: neovascularity secondary glaucoma in group A and surgery recurrence or proliferative vitroretinopathy in group B. The incidence of complication: group A3>A2>A1, A3 was significantly higher than A2 and A1, and it was statistically significant, A2>A1, but it was not statistically significant. The results of group B were the same as group A.

    CONCLUSION: Combined surgery will not be chosen if it is possible, and intraocular lens should not be implanted at once if the operation was influenced.

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李鹤一,高明宏,李建国.后节联合前节手术的利与弊.国际眼科杂志, 2013,13(4):762-763.

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  • 收稿日期:2012-10-30
  • 最后修改日期:2013-03-26
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  • 在线发布日期: 2013-04-07
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