视网膜内层结构紊乱与增生型糖尿病视网膜病变患者玻璃体切割手术后视力预后的相关性分析  

Correlation between disorganization of retinal inner layers and visual prognosis after vitrectomy in proliferative diabetic retinopathy patients

作　　者：徐玥 方严[1] 谢驰[1] Xu Yue;Fang Yan;Xie Chi(Department of Ophthalmology,The First Affiliated Hospital of Anhui University of Science&Technology,Huainan 232000,China)

机构地区：[1]安徽理工大学第一附属医院眼科,232000

出　　处：《中华眼底病杂志》2020年第11期867-873,共7页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察分析视网膜内层结构紊乱(DRIL)与增生型糖尿病视网膜病变(PDR)患者玻璃体切割手术(PPV)后视力预后的相关性。方法回顾性系统病例观察性研究。2019年1月至2020年1月在安徽理工大学第一附属医院眼科接受PPV治疗的PDR患者52例58只眼纳入研究。其中,男性24例29只眼,女性28例29只眼;年龄45~80岁,平均年龄(62.95±9.38)岁。所有患者均采用国际标准视力表行BCVA检查,并将结果转换为logMAR视力记录。手术前患眼平均logMAR BCVA 2.51±0.69。所有患者均由同一位医师行23G标准PPV。手术后1个月行频域OCT(SD-OCT)检查,测算患眼黄斑区直径1 mm内DRIL长度、椭圆体带(EZ)断裂长度和中心凹视网膜厚度(CMT)。根据DRIL长度将患眼分为无DRIL组、DRIL≤500μm组和DRIL>500μm组。对比分析3组患者手术后BCVA、SD-OCT各测量参数的差异。3组患者手术后BCVA比较采用Kruskal-Wallis H检验,组间两两比较采用Bonferroni校正法;各组组内手术后1、6个月BCVA比较采用Wilcoxon秩和检验。手术后1、3、6个月logMAR BCVA与SD-OCT各测量参数的相关性分析采用Spearman秩相关分析。多元逐步回归分析与手术后视力恢复的相关因素。结果手术后1个月,3组患眼间DRIL长度(χ2=52.194,P=0.000)、EZ断裂长度(F=9.558,P=0.000)比较,差异均有统计学意义;CMT比较,差异无统计学意义(F=0.817,P=0.447)。手术后1、3个月,无DRIL组与DRIL≤500μm组患眼BCVA之间的差异无统计学意义(Z=-1.846、-2.224,P=0.195、0.078);而手术后6个月,无DRIL组患眼BCVA优于DRIL≤500μm组,差异有统计学意义(Z=-2.508,P=0.036)。手术后1、3、6个月,无DRIL组患眼BCVA优于DRIL>500μm组,差异均有统计学意义(Z=-5.992、-6.275、-6.497,P<0.01);DRIL≤500μm组患眼BCVA优于DRIL>500μm组,差异均有统计学意义(Z=-4.260、-4.161、-4.099,P<0.01)。3组组内比较,无DRIL组、DRIL≤500μm组患眼手术后6个月BCVA均较手术后1个月提高,差异有统计�Objective To analyze the correlation between disorganization of retinal inner layers (DRIL) and visual prognosis after pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).Methods A retrospective observational systematic cases study. From January 2019 to January 2020, 52 patients (58 eyes) with PDR who were treated with PPV in the department of ophthalmology of The First Affiliated Hospital of Anhui University of Science & Technology were included in the study. There were 24 males (29 eyes) and 28 females (29 eyes), aged from 45 to 80 years old, with the mean age of 62.95 ±9.38 years. All patients were examined BCVA by using international standard visual acuity chart, and the results were converted into logMAR visual acuity in stastistics. The mean preoperative logMAR BCVA was 2.51±0.69. All patients underwent 23G standard PPV by the same physician. Spectral domain-OCT (SD-OCT) was performed to measure DRIL length within 1 mm of macular area diameter, ellipsoid zone (EZ) fracture length and foveal retinal thickness (CMT) one month after operation. According to the length of DRIL, the patients were divided into three groups: non-DRIL group, DRIL≤500 μm group and DRIL> 500 μm group. The differences of BCVA and the SD-OCT parameters were compared among the three groups after PPV. The postoperative BCVA of the three groups were compared by Kruskal-Wallis H test, and the pairwise comparison between the three groups were performed by Bonferroni correction method. Wilcoxon rank sum test was used to compare BCVA in each group at 1 and 6 months after operation. Spearman rank correlation analysis was used to analyze the correlation between BCVA and measurement parameters of SD-OCT at 1, 3 and 6 months after operation. Multivariate stepwise regression analysis was used to analyze the related factors of visual prognosis after operation.Results At 1 month after operation, the differences in DRIL length (χ2=52.194, P=0.000) and EZ fracture length (F=9.558, P=0.000) among the three groups

关 键 词：糖尿病视网膜病变 玻璃体切除术 视网膜内层结构紊乱 视力预后 

分 类 号：R587.2[医药卫生—内分泌] R779.6[医药卫生—内科学]