增殖性糖尿病视网膜病变患者玻璃体切除术后玻璃体再积血的影响因素及预后分析

Factors affecting postoperative vitreous hemorrhage after vitrectomy and prognostic analysis in patients with proliferative diabetic retinopathy

摘要:

目的 研究增殖性糖尿病视网膜病变（PDR）患者玻璃体切除术（PPV）后玻璃体再积血（PVH）的影响因素及预后分析。方法 回顾性分析2019年2月—2022年2月南通大学附属医院收治的156例PDR患者的临床资料。患者均行PPV手术，根据术后6个月是否发生PVH分为PVH组与非PVH组。比较两组患者临床特征，采用多因素一般Logistic回归模型分析PVH的影响因素，并对预后进行比较。结果 PDR患者PPV术后6个月内PVH发生率为13.46%（21/156）。两组患者性别、年龄、糖尿病病程、眼部激光治疗史、合并虹膜新生血管、收缩压、舒张压、视力、视野灰度值、黄斑厚度、PPV时间、术中激光光凝点数、术中填充物比较，差异均无统计学意义（P >0.05）；PVH组PDRⅥ期比例、合并增生视网膜牵引、糖化血红蛋白（HbAlc）、术后眼压均高于非PVH组（P <0.05）。多因素一般Logistic回归分析，结果显示：PDR分期［O^R=4.591（95% CI：1.997，10.550）］、合并增生视网膜牵引［O^R=3.736（95% CI：1.626，8.586）］、HbAlc ［O^R=4.293（95% CI：1.868，9.867）］、术后眼压［O^R=3.666（95% CI：1.595，8.425）］均为PDR患者PPV术后发生PVH的危险因素（P <0.05）。非PVH组预后优于PVH组（P <0.05）。结论 PDR患者PPV术后发生PVH的影响因素包括PDR分期、合并增生视网膜牵引、HbAlc、术后眼压，且PVH的发生会影响预后视力的改变。

Abstract:

Objective To study the factors affecting postoperative vitreous hemorrhage (PVH) after pars plana vitrectomy (PPV) and prognostic analysis in patients with proliferative diabetic retinopathy (PDR).Methods The clinical data of 156 patients with PDR in the Affiliated Hospital of Nantong University from February 2019 to February 2022 were collected retrospectively. All patients underwent PPV, and were divided into PVH group and non-PVH group according to whether PVH occurred 6 months after surgery. The clinical characteristics of the two groups were compared, and factors affecting the occurrence of PVH were analyzed by the multivariable Logistic regression model. Besides, the prognosis of the patients was compared between the two groups.Results The incidence of PVH within 6 months after PPV was 13.46% (21/156) among patients with PDR. There was no significant difference between the two groups in sex composition, age, course of diabetes mellitus, history of laser eye surgery, presence of iris neovascularization (NVI), systolic blood pressure (SBP), diastolic blood pressure (DBP), visual acuity, grayscale representation of visual field, macular thickness, duration of PPV, intraoperative laser photocoagulation treatment and intraoperative use of filling materials (P > 0.05). The percentage of stage VI PDR, proportion of proliferative retinal traction, level of glycosylated hemoglobin (HbAlc), and postoperative intraocular pressure in the PVH group were significantly higher than those in the non-PVH group (P < 0.05). The multivariable Logistic regression analysis showed that the PDR stage [O^R = 4.591 (95% CI: 1.997, 10.550) ], presence of proliferative retinal traction [O^R = 3.736 (95% CI: 1.626, 8.586)], the level of HbAlc [O^R = 4.293 (95% CI: 1.868, 9.867) ] and postoperative intraocular pressure [O^R = 3.666 (95% CI: 1.595, 8.425) ] were all factors affecting the occurrence of PVH after PPV in PDR patients (P < 0.05). The prognosis of the non-PVH group was better than that of the PVH group (P < 0.05).Conclusions Factors affecting the occurrence of PVH after PPV in PDR patients include the PDR stage, combination of proliferative retinal traction, the level of HbAlc, and postoperative intraocular pressure, while PVH may affect the prognosis of visual acuity.