增生型糖尿病视网膜病变玻璃体切割手术后新生血管性青光眼的危险因素分析

Risk factor analysis for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy

目的探讨增生型糖尿病视网膜病变（PDR）玻璃体切割手术后新生血管性青光眼（NVG）发生的危险因素。方法行玻璃体切割手术且随访资料完整的PDR患者301例301只眼纳入研究。其中，男性122例，女性179例；平均年龄54．9岁。平均糖尿病病程9．8年。手术后平均随访时间33．8个月。进入统计的因素包括性别、年龄、糖尿病病程，手术前肌酐、糖化血红蛋白、眼压、晶状体情况、是否接受全视网膜激光光凝（PRP）、手术中是否联合白内障超声乳化吸除手术、眼内填充物性质及手术后是否发生视网膜脱离。多因素logistic回归分析。结果301只眼中，发生NVG者12只眼，占4．0％。发生时间为手术后2～18个月，其中手术后2～6个月发生7只眼，占NVG患眼的58．3％。Logistic回归分析结果显示，手术后是否发生视网膜脱离与NVG发生呈正相关[r=2．881，比值比（0R）=17．826，95％可信区间为3．613～87．961；P〈0．001]；发生视网膜脱离的患眼较未发生视网膜脱离的患眼发生NVG的几率显著增高（OR=17．826）。性别、年龄、糖尿病病程，手术前肌酐、糖化血红蛋白水平，手术前眼压、晶状体情况、是否接受PRP，手术中是否联合白内障超声乳化吸除手术及手术后眼内填充物性质与NVG发生不相关（P〉0．05）。结论手术后视网膜脱离可能是PDR玻璃体切割手术后发生NVG的独立危险因素。

Objective To investigate the risk factors for neovascular glaucoma （NVG） after vitrectomy in proliferative diabetic retinopathy （PDR） patients. Methods Three hundred and one patients （301 eyes） with PDR who underwent vitrectomy between January 2008 and December 2013 in our hospital were retrospectively evaluated. Risk factors for NVG after vitrectomy were identified by multivariate Logistic regression analysis. Results Twelve of 301 patients （4.0%） developed postoperative NVG in 2 to 18 months after vitrectomy. The incidence of postoperative NVG peaked in 2 to 6 months after vitrectomy （7 eyes, 58.3%）. Logistic regression analysis showed that postoperative retinal detachment was a significant risk factor for postoperative NVG in eyes with PDR （P〈0. 001）. Eyes with postoperative retinal detachment were more likely to develop NVG after vitrectomy than those without postoperative retinal detachment （OR = 17. 826）. Gender, age, duration of diabetes, preoperative serum creatinine levels, glycated hemoglobin levels, preoperative intraocular pressure, preoperative lens status, combined phacoemulsification surgery and tamponade were not associated with postoperative NVG （P 〉 0.05）. Conclusion Postoperative retinal detachment is a major risk factor for NVG after vitrectomy in PDR.