玻璃體切割聯合眼內全視網膜光凝對PDR合并虹膜新生血管的視網膜供血影響

王　勇，石興東，胡博杰，邊領齋，李筱榮

?

·臨床研究·

玻璃體切割聯合眼內全視網膜光凝對PDR合并虹膜新生血管的視網膜供血影響

王勇，石興東，胡博杰，邊領齋，李筱榮

Tianjin Medical University Eye Institute,the School of Optometry and Ophthalmology,Tianjin Medical University Eye Hospital,Tianjin 300384,China

Abstract

?AIM: To investigate hemodynamic alterations of retrobulbar vessels in proliferative diabetic retinopathy (PDR) patients with anterior segment neovascularization,before and 3mo after vitrectomy combined with panretinal photocoagulation and to explore the clinical significance.

?METHODS: Color Doppler flow imaging (CDFI) was used for measurement of blood flow velocities and resistive indexes(RI) of the ophthalmic artery (OA),short posterior ciliary arteries (sPCA) and central retinal artery (CRA) in 21 eyes of 21 PDR patients with anterior segment neovascularization.CDFI parameters were obtained before and 3mo after vitrectomy combined with panretinal photocoagulation (PRP).

?RESULTS: Peak systolic velocity (PSV) and end diastolic velocity (EVD) of CRA were significantly increased after surgeries,RI were decreased significantly (P<0.05).Parameters of sPCA and OA have no change after surgeries (P>0.05).

?CONCLUSION: Vitrectomy combined with panretinal photocoagulation might increase the velocity of CRA,decrease RI and improve ocular blood supply postoperatively.It may delay or prevent the process of neovascular glaucoma.

目的：探討玻璃體切割聯合眼內全視網膜光凝對增殖性糖尿病視網膜病變(proliferative diabetic retinopathy，PDR)合并虹膜新生血管(iris neovascularization，NVI)患者視網膜供血的影響及其臨床價值。

方法：采用彩色多普勒超聲血流顯像技術(color doppler flow imaging，CDFI)檢測21例21眼PDR合并NVI患者行玻璃體切割聯合眼內光凝術前、術后3mo視網膜中央動脈(central retinal artery，CRA)、睫狀后短動脈(shot posterior ciliary artery，sPCA)、眼動脈(ophthalmic artery，OA)的收縮期峰值流速(peak systolic velocity，PSV)、舒張末期血流速度(end diastolic velocity，EDV)、阻力指數(resistance index,RI)的變化。

結果：玻璃體切割聯合眼內全視網膜光凝術后3mo CRA的PSV、EDV較術前明顯升高，而RI值下降，有統計學差異(P<0.05)。sPCA及OA各項血流參數手術前后改變無統計學差異(P>0.05)。

結論：玻璃體切割聯合眼內光凝可以提高PDR合并NVI患者術后CRA的血流速度，降低遠端視網膜血管的RI，改善眼視網膜的血液供應，延緩或阻止患者向新生血管性青光眼(NVG)的發展與發生。

彩色超聲多普勒；玻璃體切割；增殖性糖尿病視網膜病變；虹膜新生血管；血流動力學

引用：王勇，石興東，胡博杰，等.玻璃體切割聯合眼內全視網膜光凝對PDR合并虹膜新生血管的視網膜供血影響.國際眼科雜志2016;16(10):1894-1897

0　引言

隨著全球糖尿病的高發，糖尿病視網膜病變(diabetic retinopathy,DR)已成為常見的缺血性眼病，其低灌注、高阻力、高回流狀態的微循環障礙是增殖性糖尿病視網膜病變(proliferative diabetic retinopathy,PDR)形成的主要因素，視網膜缺血面積的逐漸增加會導致視網膜色素上皮細胞(retinal pigment epithelium,RPE)和Müller細胞合成血管內皮生長因子(vascular endothelial growth factor，VEGF)，引發視網膜新生血管、虹膜新生血管(iris neovascularization，NVI)甚至發生新生血管性青光眼(neovascular glaucoma，NVG)[1]。……