增生型糖尿病视网膜病变患眼玻璃体切割手术未联合眼内填充治疗后玻璃体积血的危险因素分析

Risk factor analysis of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy

目的观察分析增生型糖尿病视网膜病变(PDR)患眼微创玻璃体切割手术(PPV)后玻璃体积血(VH)的危险因素。方法2015年6月至2017年6月在河南省人民医院接受23G微创PPV(MIV)未联合眼内填充治疗且随访资料完整的PDR患者103例103只眼纳入研究。其中,男性58例58只眼,女性45例45只眼;平均年龄(58.37±10.14)岁;平均糖尿病病程(8.7±7.2)年。所有患者均接受标准经睫状体平坦部三通道23G MIV。纳入统计分析的基线因素包括性别、年龄、糖尿病病程、手术前血压控制、糖化血红蛋白(HbA1c)、血肌酐(CREA)、是否服用抗凝药;眼部因素包括手术前是否合并VH、手术前是否完成全视网膜激光光凝(PRP)、手术前7 d内是否行抗VEGF药物治疗、晶状体状态、是否合并虹膜新生血管(NVI)、手术后1 d是否低眼压;手术因素包括手术中是否视盘新生血管(NVD)出血、纤维血管膜(FVM)残留、激光光凝点数以及是否联合白内障超声乳化手术。采用二元多因素logistic回归分析。结果103只眼中,发生PPV后VH(PVH) 29只眼(28.15%),发生的时间为手术后1 d^6个月;积血自行吸收18只眼,再次治疗11只眼。单因素分析结果显示,年龄(t=2.124,P=0.036)、手术前7 d内抗VEGF药物治疗(χ^2=7.105,P=0.008)、手术中NVD出血(χ^2=10.158,P=0.001)、FVM残留(χ2=8.445,P=0.004)与PVH发生相关;性别(χ^2=0.021, P=0.884)、糖尿病病程(t=0.87,P=0.386)、手术前血压控制(χ^2=2.004,P=0.157)、HbA1c(t=1.211,P=0.229)、CREA(t=0.851,P=0.397)、是否服用抗凝药(χ^2=0.985,P=0.321)、是否合并VH(χ^2=0.369,P=0.544)、是否完成PRP(χ^2=1.122,P=0.727)、是否合并NVI(χ^2=2.635,P=0.105)、晶状体状态(χ^2=0.172,P=0.679)、手术后1 d是否低眼压(χ^2=1.503,P=0.220)、手术中激光光凝点数是否>1000点(χ^2=1.391,P=0.238)以及是否联合白内障超声乳化手术(χ^2=0.458,P=0.499)与PVH发生无相关。多因素logistic回归分析结果显示,年龄轻(OR=1.065,P=0.009)、手术中NVD出血(OR=6.048,P=0.001)为PVH的危险因素。结论年龄轻和手术中NVD出血是PDR患眼MIV未联合眼内填充治疗后PVH发生的危险因素。

Objective To investigate the risk factors of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy (PDR). Methods From June 2015 to June 2017, 103 eyes of 103 patients with PDR diagnosed and underwent minimalvitrectomy in Henan Provincial People's Hospital were enrolled in the study. There were 58 males and 45 females, with the average age of 58.37± 10.14 years and diabetes duration of 8.7±7.2 years. Baseline systemic parameters including sex, age, diabetes duration, hypertension, HbAlc, creatinine, whether received anticoagulants, ocular parameters including whether combined with vitreous hemorrhage, whether finished panretinal photocoagulation (PRP), whether received treatment of anti-VEGF, whether combined with iris neovascularization (NVI), lens status preoperatively, whether hypotony postoperatively and intraoperative parameters including whether disc neovascularization (NVD) bleeding, whether fibrovascular membrane (FVM) residual, laser points, whether combined with cataract phacoemulsification were identified by multivariate logistic regression analysis. Results Twenty-nine of 103 eyes (28.15%) developed PVH in 1 day to 6 months after surgery, with self absorption of 18 eyes and reoperation of 11 eyes. Univariate analysis showed there were significant differences in age (t=2.124, P=0.036), anti-VEGF(X^2=7.105, P=0.008), NVD bleeding (X^2=10.158, P=0.001) and FVM residual(X^2=8.445, P=0.004) between patients with and without postoperative vitreous hemorrhage. Sex (X^2=0.021, P=0.884), diabetes duration (t=0.87, P=0.386), hypertension (X^2=2.004, P=0.157), HbAlc (Z=1.211, P=0.229), creatinine (t=0.851, P=0.397), preoperative oral anticoagulants (X^2=0.985, P=0.321), preoperative vitreous hemorrhage (X^2=0.369, P=0.544), PRP (X^2= 1.122, P=0.727), NVI (X^2=2.635, P=0.105), lens status (X^2=0.172, P=0.679), hypotony postoperatively (X^2=1.503, P=0.220), laser points (X^2= 1.391, P=0.238) and combined phacoemulsification surgery (X^2=0.458, P=0.499) were not associated with PVH. Multivariate logistic regression analysis revealed the more PVH appeared in younger (OR= 1.065, P=0.009) and NVD bleeding (OR=6.048, P=0.001) patients. Conclusion Younger age and NVD bleeding are the important risk factors for PVH after minimal vitrectomy without endotamponade in PDR.