增生型糖尿病视网膜病变患者玻璃体切割手术后新生血管性青光眼危险因素分析

Risk factors associated with 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（PPV）后新生血管性青光眼（NVG）发生的危险因素。 方法 回顾性病例研究。行PPV治疗的PDR患者137例137只眼纳入研究。其中，男性85例，女性52例。平均年龄（60.1±8.8）岁。平均糖尿病病程（10.2±3.6）年。存在同侧颈动脉狭窄49例。PPV前3 d行雷珠单抗或康柏西普玻璃体腔注射治疗53只眼。均行标准经睫状体平坦部三通道23G PPV治疗。手术后平均随访时间11.5个月。手术后4～6周行荧光素眼底血管造影检查，观察视网膜无灌注区残留情况。对同侧颈动脉狭窄、PPV后视网膜无灌注区残留、PPV前抗血管内皮生长因子（VEGF）药物治疗情况行多因素logistic回归分析。 结果 137只眼中，发生NVG者20只眼，占14.6%。Logistic回归分析结果显示，同侧颈动脉狭窄[比值比（OR）=5.048，95%可信区间（CI）=2.057～12.389，P=0.000]、PPV后视网膜无灌注区残留（OR=4.274, 95%CI= 1.426～12.809，P=0.009）与PPV后NVG发生呈显著相关；PPV前抗VEGF药物治疗与PPV后NVG发生无明显相关（OR=1.426，95%CI=0.463～4.395，P=0.536）。但PPV前抗VEGF药物应用与未应用者之间NVG发生时间比较，差异有统计学意义（t=？4.370，P=0.000）。 结论 存在同侧颈动脉狭窄、PPV后视网膜无灌注区残留是PDR患者PPV后NVG发生的危险因素；PPV前应用抗VEGF药物治疗可延迟NVG的发生。

Objective To investigate the risk factors associated with neovascular glaucoma （NVG） after pars plana vitrectomy （PPV） in eyes with proliferative diabetic retinopathy （PDR）. Methods Retrospective study. One hundred and thirty-seven patients （137 eyes） with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was （60.1±8.8） years old. The duration of diabetes was （10.2±3.6） years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography （FFA） was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor （VEGF） drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients （14.6%） developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio （OR） =5.048, 95% confidence interval （CI） 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV （OR=4.274, 95%CI 1.426-12.809,P=0.009） were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not （OR=1.426, 95%CI 0.463-4.395,P=0.536）. But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not （t=？4.370,P=0.000）. Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.