玻璃体切除术对糖尿病性视网膜病变患者眼表及泪液成分的影响

Effect of vitrectomy on ocular surface and tear composition in patients with diabetes retinopathy

目的探讨23G玻璃体切除术(PPV)对增殖型糖尿病性视网膜病变(PDR)患者眼表及泪液中神经肽P物质(SP)和降钙素基因相关肽(CGRP)浓度的影响。方法前瞻性队列研究。随机收集2021年7月至2021年10月于苏北人民医院眼科就诊并行PPV手术的患者共30例(30眼),其中糖尿病性视网膜病变患者15例(15眼)为PDR组,非糖尿病性视网膜病变患者15例(15眼)为对照组。所有患者术后随访30 d。对比两组患者手术前后非侵入性首次泪膜破裂时间(NITBUTf)、角膜荧光素染色(CFS)评分,并用ELISA方法检测两组患者手术前后泪液中SP和CGRP浓度。结果术后7 d,PDR组NITBUTf(3.94±1.62)s较术前(7.21±1.37)s降低(F=125.20,P<0.001),且明显低于对照组(5.09±1.22)s(F=53.12,P=0.001);CFS评分[4.00(2.50,5.50)]分较术前[0.00(0.00,0.50)]分明显升高(Z=59.25,P<0.001),且显著高于对照组[3.00(1.88,4.13)]分(U=377.50,P=0.012);患者泪液中SP、CGRP浓度[(1.77±0.96)ng/mL、(2.09±1.59)ng/mL]较术前[(2.94±0.95)ng/mL、(4.95±1.39)ng/mL]显著降低(F=92.75、63.75,均P<0.05);且术后7 d泪液中SP、CGRP浓度明显低于对照组术后7 d(2.55±0.97)ng/mL、(4.22±1.30)ng/ml(F=16.15、8.28,均P<0.05)。术后30 d,PDR组NITBUTf(4.11±1.21)s较术后7 d略上升(F=125.20,P=0.732),但较术前下降(P<0.001),且明显低于对照组(5.09±1.22)s(F=53.12,P<0.001);术后30 d CFS评分[3.00(2.50,3.50)]分较术后7 d稍降低(Z=59.25,P=0.064),但仍高于术前(P<0.001)及对照组[1.00(0.50,1.50)]分(U=65.00,P<0.001);泪液中SP、CGRP(4.40±1.11)ng/mL、(5.83±1.54)ng/mL浓度较术前及术后7 d均显著升高(F=92.75、63.75,均P<0.05),但低于对照组(6.81±1.31)分、(7.13±1.66)ng/mL(F=16.15、8.28,均P<0.001)。结论23G PPV治疗PDR患者术后泪膜稳定性下降,损伤角膜上皮;泪液中SP和CGRP浓度低。

Objective To investigate the effect of 23G par plana vitrectomy(PPV)on ocular surface indexes and concentrations of neuropeptide P(SP)and calcitonin gene-related peptide(CGRP)in tear fluid in patients with proliferative diabetic retinopathy(PDR).Methods This was a prospective cohort study.A total of 30 eyes of 30 patients who underwent PPV in the North Jiangsu People’s Hospital from Jul.2021 to Oct.2021 were randomly collected.There were 15 patients with diabetic retinopathy in the PDR group and 15 patients with non-diabetic retinopathy in the control group.All patients were followed up for 30 days after surgery.The non-invasive first tear film break-up time(NITBUTf)and corneal fluorescein staining(CFS)scores before and after surgery were compared between the two groups,and ELISA detected the concentrations of SP and CGRP in tears before and after surgery.Results At 7 days after PPV,NITBUTf(3.94±1.62)s in the PDR group was lower than that before surgery(7.21±1.37)s(F=125.20,P<0.001),and significantly lower than that in the control group(5.09±1.22)s(F=53.12,P=0.001).The CFS score[4.00(2.50,5.50)]was significantly higher than the[0.00(1.00)]before surgery(Z=59.25,P<0.001)and significantly higher than that of the control group[(3.00(2.25)](U=377.50,P=0.012).The concentrations of SP and CGRP(1.77±0.96)ng/mL and(2.09±1.59)ng/mL in tear were significantly lower than the(2.94±0.95)ng/mL and(4.95±1.39)ng/mL(F=92.75,63.75;all P<0.05)before surgery,and where significantly lower than those in the control group[(2.55±0.97)ng/mL,(4.22±1.30)ng/ml](F=92.75,63.75;P<0.05).At 30 days after PPV,NITBUTf(4.11±1.21)s in the PDR group increased slightly than the(F=125.20,P=0.732)at 7 days after surgery.Furthermore,it still decreased significantly compared with the preoperative period[(F=53.12,P<0.001)]and significantly lower than the(5.09±1.22)s in the control group(P<0.001).The control group has recovered to the preoperative level(P=1.000).The CFS score of 3.00(1.00)was slightly lower(χ^(2)=59.25,P=0.064).However,it was still higher than the preoperative CFS score(P<0.001)and significantly higher than the 1.00(1.00)(U=65.00,P<0.001)in the control group,and the control group recovered to the preoperative level(P=0.075).The concentrations of SP,CGRP(4.40±1.11)ng/mL,and(5.83±1.54)ng/mL in tear were significantly higher than those in the preoperative and postoperative 7 d(F=92.75,63.75;P<0.05),which were still significantly lower than the(6.81±1.31)ng/mL and(7.13±1.66)ng/mL in the control group(F=16.15,8.28;P<0.001).Conclusion After 23G PPV for the treatment of PDR,the stability of tear membrane decreases more significantly,with corneal epithelium damage.The SP and CGRP concentrations in tears are lower.