C3 F8或硅油填充对增生型糖尿病视网膜病变玻璃体切割手术后玻璃体再积血及视力预后的影响

Effects of C3 F8 or silicon oil tamponade on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy

目的：观察 C3 F8或硅油填充对增生型糖尿病视网膜病变（PDR）玻璃体切割手术后玻璃体再积血及视力预后的影响。方法首次行玻璃体切割手术联合 C3 F8或硅油填充的 PDR 患者121例127只眼纳入研究。根据玻璃体腔填充物不同将患眼分为 C3 F8填充组、硅油填充组,分别为53例56只眼和68例71只眼。两组患者性别（χ2=0.956）、年龄（t =1.122）、糖尿病病程（t =0.627）、空腹血糖（t =1.049）、收缩压（t=1.056）、舒张压（t=0.517）、高血压病史（χ2=0.356）、肾病史（χ2=1.242）、手术前行视网膜激光光凝（χ2=1.225）及同期晶状体摘除（χ2=1.299）眼数比较,差异均无统计学意义（P 〉0.05）；糖尿病视网膜病变分期（Z =2.479）、最佳矫正视力（BCVA）（Z =2.066）比较,差异均有统计学意义（P 〈0.05）。所有患眼行常规睫状体平坦部三切口玻璃体切割手术。手术后随访6个月~4.0年,平均随访时间2.0年。观察并比较两组患眼手术后玻璃体再积血的发生率、时间及 BCVA 变化情况。结果C3 F8填充组56只眼中,发生玻璃体再积血14只眼,占25.00%。发生玻璃体再积血时间为手术后7~225 d,平均时间为（64.64±59.09）d,且30~60 d 发生比例最高,占35.71%。硅油填充组71只眼中,硅油取出手术后发生玻璃体再积血7只眼,占9.89%。发生玻璃体再积血时间为3~65 d,平均时间为（25.29±20.46）d,且15~30 d 发生比例最高,占42.86%。与 C3 F8填充组比较,硅油填充组手术后玻璃体再积血率显著降低,差异有统计学意义（χ2=5.200,P 〈0.05）。两组患眼手术后 BCVA 均较手术前提高,差异有统计学意义（Z =2.472、3.114,P 〈0.05）。两组间比较,硅油填充组手术后 BCVA 低于 C3 F8填充组,差异有统计学意义（Z =1.968,P 〈0.05）。结论C3 F8与硅油填充均可改善 PDR 患者玻璃体切割手术后视力。与 C3 F8相比,硅油填充可显著降低并延迟手术后玻璃体再积血。

Objective To compare the effects of intravitreal tamponade of C3 F8 with silicon oil on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy （PDR）.Methods The clinical data of 121 patients （127 eyes）who underwent primary vitrectomy due to PDR were analyzed retrospectively.All the patients were divided into two groups according to different intravitreal tamponade, including C3 F8 tamponade group （53 patients with 56 eyes ） and silicone oil tamponade group （68 patients with 71 eyes）.There was no difference of gender （χ2 = 0.956 ）,age （t =1.122）,duratiion of diabetes （t=0.627）,fasting blood glucose （t=1.049）,systolic pressure （t=1.056）, diastolic pressure （t = 0.5 1 7 ）, history of hypertension （χ2 = 0.356 ）, nephropathy （χ2 = 1.242 ）, preoperative laser photocoagulation （χ2 = 1.225 ）and All the patients underwent three port pars plana vitrectomy.The mean follow-up was 2 years ranging from 6 months to 4 years.And then the incidence and onset time of postoperative vitreous hemorrhage and postoperative BCVA of the two groups were compared. Results Postoperative vitreous hemorrhage occurred in 14 of 56 eyes （25.00%）in C3 F8 tamponade group. The average onset time of postoperative vitreous hemorrhage were （64.64 ＆#177; 59.09）days ranging from 7 -225 days and mostly were within 30-60 days （35.71%,5/14）.Postoperative vitreous hemorrhage also occurred in 7 of 71 eyes （9.89%）of silicone oil tamponade group after silicone oil removal with an average onset time of （25.29±20.46）days ranging from 3-65 days and were mostly within 1 5-30 days （42.86%, 3/7）.There was a significant difference in the incidence of postoperative vitreous hemorrhage between the two groups （χ2 = 5.200,P 〈0.05 ）.BCVA of the two groups was improved significantly after operation （Z =2.472,3.1 14;P〈0.05）.Postoperative BCVA of silicone oil tamponade group was poorer than C3 F8 tamponade group （Z =1.968,P 〈0.05）.Conclusion Both C3 F8 and silicone oil tamponade can improve the visual acuity after vitrectomy for PDR.Compared with C3 F8 ,silicone oil tamponade had lower incidence and late onset of postoperative vitreous hemorrhage after vitrectomy for PDR.