微创玻璃体切除术治疗PDR的效果及术后PVH的影响因素分析  

Efficacy of minimally invasive vitrectomy on the treatment of proliferative diabetic retinopathy and the influencing factors of posterior vitreous hemorrhage after vitrectomy

作　　者：杜倩 白石 杨芳 Du Qian;Bai Shi;Yang Fang(Department of Ophthalmology,Nanyang Nanshi Hospital,Nanyang 473000,China)

机构地区：[1]南阳南石医院眼科,南阳473000

出　　处：《中华眼外伤职业眼病杂志》2024年第12期931-937,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察微创玻璃体切除术治疗增生型糖尿病视网膜病变(PDR)的效果及分析术后迟发性玻璃体积血(PVH)的影响。方法回顾性队列研究。收集南阳南石医院2019年6月至2023年11月手术治疗的100例PDR患者临床资料。依据手术不同分为两组,其中行常规20 G玻璃体切除术者50例为对照组,行25 G微创玻璃体切除术者50例为观察组;比较两组术前、术后3 d黄斑中心区视网膜厚度(CMT)、黄斑完整性指数(MI)、最佳矫正视力(BCVA,logMAR)、眼表疾病指数(OSDI)评分。依据术后是否存在PVH将入组患者分为发生组、未发生组,筛选影响PDR患者术后PVH的危险因素。结果术后3 d,对照组、观察组黄斑、眼部功能较术前均有明显改善,且观察组CMT、MI、BCVA、OSDI[(260.62±18.00)μm、79.40±4.12、1.10±0.10、(11.86±1.50)分]均低于对照组[(282.50±18.50)μm、83.08±4.70、1.35±0.12、(13.08±1.75)分],组间差异均具有统计学意义(t=5.99、4.16、11.32、3.77,均P<0.001)。PDR患者术后PVH发生率为28.00%(28/100)。与未发生组比较,发生组合并黄斑病变比例、20 G玻璃体切除术治疗比例、血管闭塞比例、增生性视网膜牵引比例及糖化血红蛋白水平、OSDI评分均较高,组间差异有统计学意义(均P<0.05)。Logistic多因素回归分析结果显示,合并黄斑病变(OR=1.84,95%CI:1.63~2.45,P<0.001)、高糖化血红蛋白(OR=1.80,95%CI:1.60~2.15,P=0.005)、20 G玻璃体切除术(OR=1.82,95%CI:1.68~2.34,P=0.010)、血管闭塞(OR=1.84,95%CI:1.62~2.36,P<0.001)、增生性视网膜牵引(OR=1.84,95%CI:1.66~2.37,P<0.001)、术后高OSDI(OR=1.79,95%CI:1.58~2.26,P=0.008)与PDR患者术后PVH相关。结论微创玻璃体切除术可有效减轻PDR患者视网膜黄斑水肿、提高术后视力;合并黄斑病变、高糖化血红蛋白、手术方式、血管闭塞、增生性视网膜牵引、术后高OSDI是影响PDR患者术后PVH的危险因素。Objective To observe the efficacy of minimally invasive vitrectomy on the treatment of proliferative diabetic retinopathy(PDR)and analyze the influencing factors of posterior vitreous hemorrhage(PVH).Methods This was a retrospective cohort study.The clinical data of 100 patients with PDR who were surgically treated in Nanyang Nanshi Hospital from Jun.2019 to Nov.2023 were analyzed.Based on different surgical methods,50 cases who underwent conventional 20 G vitrectomy were divided into the control group,and 50 cases who underwent 25 G minimally invasive vitrectomy were divided into the observation group.Central macular thickness(CMT),macular integrity index(MI),best corrected visual acuity(BCVA,logMAR)and ocular surface disease index(OSDI)were compared between the two groups before and 3 days after surgery.Depending on whether there was delayed PVH after surgery,the enrolled patients were then divided into an occurrence group and a non-occurrence group,and the risk factors affecting PVH in PDR patients were screened.Results At 3 days after operation,the macular and ocular functions of the control group and the observation group significantly improved compared with those before operation.CMT,MI,BCVA,and OSDI[(260.62±18.00)μm,79.40±4.12,1.10±0.10,(11.86±1.50)points]in the observation group were lower than those in the control group[(282.50±18.50)μm,83.08±4.70,1.35±0.12,(13.08±1.75)minutes].The differences between the two groups were statistically significant(t=5.99,4.16,11.32,3.77;all P<0.001).The incidence of postoperative delayed vitreous hemorrhage in PDR patients was 28.00%(28/100).Compared with the non-occurrence group,the occurrence group had higher proportions of maculopathy,20 G vitrectomy treatment,vascular occlusion,proliferative retinal traction,and glycated hemoglobin level,as well as higher OSDI score.The differences between the groups were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that macular degeneration(OR=1.84,95%CI:1.63-2.45,P<0.001),high glyc

关 键 词：增生型糖尿病视网膜病变 玻璃体切除术 黄斑 迟发性玻璃体积血 

分 类 号：R58[医药卫生—内分泌]