增生性糖尿病性视网膜病变玻璃体切除术后脉络膜脱离的危险因素分析  

Analysis of risk factors of choroidal detachment after vitrectomy for proliferative diabetic retinopathy

作　　者：高韶晖 裴晗 赵朝霞 吴众 金学民[2] Gao Shaohui;Pei Han;Zhao Zhaoxia;Wu Zhong;Jin Xuemin(Department of Ophthalmology,Henan Provincial People’s Hospital,Henan Eye Hospital,Henan Eye Institute,People’s Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]河南省人民医院眼科河南省立眼科医院河南省眼科研究所郑州大学人民医院,郑州450003 [2]郑州大学第一附属医院眼科,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2022年第9期647-651,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190818)。

摘　　要：目的分析增生性糖尿病视网膜病变(PDR)患者经玻璃体切除术后脉络膜脱离的危险因素。方法回顾性病例系列研究。纳入睫状体平坦部行23G/25G+玻璃体切除术的PDR 171例(171只眼)。其中男性78例, 女性93例;年龄(56.04±11.13)岁。对比分析术后脉络膜脱离的危险因素。术后随访3~4个月。结果 171只眼中, 发生脉络膜脱离者11只眼(6.43%), 发生时间为手术后1 d。发生与未发生脉络膜脱离者两组手术过程中巩膜伤口缝合与否(χ^(2)=4.21,P=0.040)、手术后1 d眼压(t=7.05, P<0.001)和不同填充物所占比例(χ^(2)=5.16,P=0.023)比较差异均有统计学意义。性别(χ^(2)=0.41, P=0.524)、年龄(t=1.59, P=0.113)、糖尿病病程(t=1.16, P=0.248)、血清白蛋白ALB(t=1.598, P=0.110)、糖化血红蛋白HbA1c(t=1.12, P=0.263)、PDR分期(χ^(2)=0.49,P=0.114)、术前眼压(t=0.92, P=0.358)、晶状体状态(χ^(2)=0.03, P=0.873)、术前7 d内抗VEGF治疗(χ^(2)=0.57, P=0.451)、是否联合白内障手术(χ^(2)=0.00, P=0.969)、激光光凝点数(χ^(2)=0.06, P=0.812)、手术时长(χ^(2)=0.23, P=0.634), 以及切口类型(χ^(2)=0.70, P=0.403)等因素比较, 差异均无统计学意义。巩膜创口未缝合(OR=0.23, P=0.003)、填充物为灌注液(OR=0.24, P=0.004)和术后1 d低眼压(OR=0.11,P<0.001)是脉络膜脱离的危险因素。结论巩膜创口未缝合、灌注液填充和手术后1 d低眼压是PDR患者玻璃体切除术后脉络膜脱离的危险因素;缝合巩膜伤口、填充硅油或气体是脉络膜脱离的保护因素。Objective To analyze the risk factors of choroidal detachment after vitrectomy for proliferative diabetic retinopathy(PDR).Methods This was a case series retrospective study.Total of 171 eyes of 171 patients with PDR who underwent 23G/25G+pars plana vitrectomy were enrolled.There were 78 males and 93 females,with the average age of(56.04±11.13)years.The risk factors of choroidal detachment after vitrectomy were comparatively investigated.The follow-up time was 3-4 months.Results Choroidal detachment occurred in 11 eyes(6.43%)at 1 day after surgery.There were statistically significant difference in the rate with or without suture of scleral wound during operation(χ^(2)=4.21,P=0.040),intraocular pressure at 1 day after surgery(t=7.05,P<0.001)and tamponade material(χ^(2)=5.16,P=0.023)between the two groups with and without choroidal detachment.There were no significant differences in gender(χ^(2)=0.41,P=0.524),age(t=1.59,P=0.113),duration of diabetes(t=1.16,P=0.248),serum albumin(t=1.60,P=0.110),hemoglobin A1c(t=1.12,P=0.263),PDR stage(χ^(2)=0.49,P=0.114),preoperative IOP(t=0.92,P=0.358),lens state(χ^(2)=0.03,P=0.873),anti-VEGF therapy at 7 days before surgery(χ^(2)=0.57,P=0.451),whether combined with cataract phacoemulsification(χ2=0.00,P=0.969),laser spots(χ^(2)=0.06,P=0.812),surgery time(χ^(2)=0.23,P=0.634)and incision type(χ2=0.70,P=0.403)between the patients with and without choroidal detachment.Unsutured scleral wound(OR=0.23,P=0.003),fluid tamponade(OR=0.24,P=0.004)and lower intraocular pressure at 1 day after surgery(OR=0.11,P<0.001)were the risk factors for choroidal detachment.Conclusion Unsutured scleral wound,fluid tamponade and ocular hypotention on the first day are risk factors for choroidal detachment after PPV surgery in PDR.Sutured scleral wound and silicone oil/air tamponade are protective factors for choroidal detachment.

关 键 词：玻璃体切除术 糖尿病视网膜病变 视网膜脱离 脉络膜疾病 因素 影响 

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