增生性糖尿病视网膜病变患者经玻璃体切割术治疗后发生新生血管性青光眼的影响因素

Influencing factors of neovascular glaucoma in patients with proliferative diabetic retinopathy after pars plana vitrectomy

目的探讨增生性糖尿病视网膜病变(PDR)经玻璃体切割术(PPV)治疗后新生血管性青光眼(NVG)发生的影响因素。方法回顾性分析2021年1月至2023年1月南昌普瑞眼科医院65例行PPV治疗的PDR患者的临床资料,根据术后是否发生NVG分为发生组(n=18)与未发生组(n=47)。收集患者的一般资料,包括性别、年龄、体重指数、糖尿病病程、PDR分期、是否注射胰岛素、是否合并心脑血管疾病、术前眼压、空腹血糖、是否贫血、是否合并视网膜脱落、是否联合白内障手术、术前是否有房角或虹膜新生血管患眼等。对一般资料进行单因素分析,再对差异有统计学意义的因素进行多因素logistic回归分析。结果65例行PPV治疗的PDR患者中,发生18例NVG,发生率为27.69%。单因素分析显示,两组不同的体重指数、糖尿病病程、PDR分期、是否注射胰岛素、术前眼压、是否合并视网膜脱落、是否联合白内障手术比较,差异无统计学意义(P>0.05);两组不同的性别、年龄、是否合并心脑血管疾病、空腹血糖、是否贫血、是否有房角或虹膜新生血管患眼比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,性别为男(β=1.567、P=0.024、0R=4.792、95%CI:1.224~18.766)、年龄<60岁(β=2.380、P=0.003、0R=10.800、95%CI:2.225~52.413)、合并心脑血管疾病(β=1.707、P=0.003、OR=5.814、95%CI:1.791~18.870)、空腹血糖≥7.0mmol/L(β=1.655、P=0.006、0R=5.231、95%CI:1.623~16.853)、贫血(β=1.892、P=0.002、OR=6.635、95%CI:2.010~21.900)、术前有房角或虹膜新生血管患眼(β=1.905、P=0.004、0R=6.720、95%CI:1.808~24.981)是影响的独立危险因素(P<0.05且OR>1)。结论PDR患者PPV术后NVG发生影响因素较多,包括性别为男、年龄<60岁、合并心脑血管疾病、空腹血糖≥7.0mmol/L等,临床需对相关情况加以重视,并做好预防工作。

Objective To investigate the related factors of neovascular glaucoma(NVG)after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).Methods The clinical data of 65 PDR patients who underwent PPV in Nanchang Bright Eye Hospital from January 2021 to January 2023 were retrospectively analyzed.According to whether NVG occurred after surgery,they were divided into the occurrence group(n=18)and the non-occurrence group(n=47).The general data of the patients were collected,including gender,age,body mass index,duration of diabetes,PDR stage,insulin injection,car-diovascular and cerebrovascular diseases,preoperative intraocular pressure,fasting blood glucose,anemia,retinal detach-ment,combined cataract surgery,preoperative anterior chamber angle or iris neovascularization.The general data were ana-lyzed by univariate analysis,and then the factors with statistically significant differences were analyzed by multivariate lo gistic regression analysis.Results Among the 65 PDR patients treated with PPV,18 cases of NVG occured,with an inci-dence of 27.69%.Univariate analysis showed that there were no significant differences in body mass index,duration of dia-betes,PDR stage,insulin injection,preoperative intraocular pressure,retinal detachment,and combined cataract surgery between the two groups(P>0.05).There werestatistically significant differences between the two groups in gender,age,whether complicated with cardiovascular and cerebrovascular diseases,fasting blood glucose,anemia,and whether there were anterior chamber angle or iris neovascularization(P<0.05).Multivariate logistic regression analysis showed that male gender(β=1.567,P=0.024,OR=4.792,95%CI:1.224-18.766),age<60 years(β=2.380,P=0.003,OR=10.800,95%CI:2.225-52.413),cardiovascular and cerebrovascular diseases(β=1.707,P=0.003,0R=5.814,95%CI:1.791-18.870),fasting blood glucose≥7.0 mmol/L(β=1.655,P=0.006,OR=5.231,95%CI:1.623-16.853),anemia(β=1.892,P=0.002,OR=6.635,95%CI:2.010-21.900),preoperative or iris neovascularization corner of the eye(β=1.905,P=0.004,OR=6.720,95%CI:1.808-24.981)were the independent risk factors(P<0.05 and 0R>1).Conclusion There are many influencing factors for NVG affer PPV in PDR patients,including male gender,age<60 years old,combined with cardiovascular and cerebrovascular diseases,fasting blood glucose≥7.0 mmol/L,etc.Clinical attention should be paid to relevant conditions and prevention work should be done.