Pregnancy after vitrectomy for proliferative diabetic retinopathy

A 26-year-old female with insulin-dependent diabetes of 16 years duration had a vitrectomy for a dense non-resolving vitreous haemorrhage. Two months later she became pregnant. She delivered a healthy baby and despite the known adverse effects of pregnancy on retinopathy no deterioration occurred in visual acuity or in retinal appearance.     

增殖型糖尿病视网膜病变玻璃体手术与虹膜红变发生的关系

目的探讨增殖型糖尿病视网膜病变(PDR)行玻璃体手术后,虹膜红变(INV)发生的危险因素。方法对451例PDR(536眼)行玻璃体手术治疗后INV的发生进行多因素logistic回归分析。结果44眼(8.2%)发生INV,12眼(2.2%)出现新生血管性青光眼;以术后1个月到半年时间段内INV发生率最高(48.3%)。Logistic回归分析显示术前即存在INV和一次术后视网膜是否复位这两个因素与PDR患者玻璃体手术后INV的发生相关(P<0.001);PDRⅣ、Ⅴ、Ⅵ期发生率比较接近(分别为8.5%,6.1%,9.0%);术前完成全视网膜光凝的患者发生术后INV的比例更低(6.2%vs9.9%)。晶体状态为保留自身晶体的患者INV发生率最低(6.8%),与人工晶状体植入后囊完整组(8.9%)相比,差异无统计学意义(P=0.525)。结论术前合并INV和一次术后视网膜脱离是术后INV发生的主要危险因素。PDR严重程度与INV发生没有明显关系。     

四切口玻璃体手术治疗增殖性糖尿病视网膜病变的疗效观察

目的 探讨经睫状体平坦部四切口玻璃体手术治疗增殖性糖尿病视网膜病变(PDR)的疗效.方法 对18例(22眼)行经睫状体平坦部四切口玻璃体手术的PDR患者进行回顾性分析,随访6～18个月.结果 术后视力改善17眼(77.27%);3眼视力不变(13.64%);2眼视力下降(9.09%).结论 四切口玻璃体手术使术者得以采用双手操作行眼内的膜分离、膜剥除,可明显缩短手术时间,提高手术效率,减少组织损伤,是治疗PDR的较好方法.     

玻璃体手术治疗增生型糖尿病视网膜病变544眼疗效分析

目的观察玻璃体手术治疗增生型糖尿病视网膜病变（PDR）的疗效及并发症。方法对455例（544眼）行玻璃体手术治疗的PDR连续性病例进行回顾性分析,比较使用不同眼内填充物的结果。结果544眼中视力≥0.02者由术前的267眼（49.1%）增加到术后的444眼（81.6%）,其中视力≥0.1者由术前的110眼（20.2%）增加到术后的283眼（52.0%）;总视网膜在位眼数499眼（91.7%）,其中灌注液组高达96.2%;白内障发生率在灌注液组最低,为7.9%（18/227）,硅油组最高,为21.0%（17/81）,气体组为14.8%（16/108）;术后玻璃体出血者气体组16眼（11.6%）,硅油组硅油取出后24眼（20.2%）,灌注液组59眼（20.6%）。结论对于无视网膜裂孔及新生血管并发症危险的PDR患者,玻璃体手术保留灌注液即可获得良好预后;术前存在视网膜脱离的PDRⅥ期并非选择硅油或气体的指征。     

普拉洛芬联合美多丽在增生性糖尿病视网膜病变玻璃体切割手术中对瞳孔大小的影响

［摘要］　目的　观察普拉洛芬联合美多丽在增生性糖尿病视网膜病变玻璃体切割手术中对瞳孔大小的影响。方法　选取2020年4月至2021年5月因增生性糖尿病视网膜病变在贵阳市第一人民医院眼科行玻璃体切割手术的患者89例（126眼）,按照随机数字表法分为观察组和对照组各63眼。观察组抗血管内皮生长因子（VEGF）术后第1天开始使用普拉洛芬,连续用药3 d,并在术前30 min使用美多丽散瞳;对照组抗VEGF术后,仅术前30 min使用美多丽散瞳。分别在手术前、术中1 h、手术结束时（≥2 h）测量瞳孔大小,比较两组各时间点的平均瞳孔面积大小。结果　观察组各时点平均瞳孔面积均大于对照组,差异有统计学意义（P<0.05）。两组术中1 h平均瞳孔面积与术前比较差异均无统计学意义（P>0.05）。两组手术结束时（≥2 h）平均瞳孔面积均低于术前,差异有统计学意义（P<0.05）,但观察组平均瞳孔面积缩小程度小于对照组,差异有统计学意义（P<0.05）。结论　普拉洛芬可以有效抑制增生性糖尿病视网膜病变玻璃体切割手术中瞳孔缩小,联合美多丽使用可以维持术中长时间散瞳状态,给手术创造良好的视野。     

康柏西普玻璃体腔注射辅助25G玻璃体切割手术治疗增殖性糖尿病视网膜病变的疗效观察

目的观察康柏西普玻璃体腔注射辅助25G玻璃体切割手术治疗增殖性糖尿病视网膜病变(PDR的疗效。方法回顾性分析52例(52眼)需行玻璃体切割的PDR患者临床资料,按手术前7 d是否行玻璃体腔注射康柏西普分为治疗组25例(25眼)和对照组27例(27眼)。治疗组在术前7 d予以康柏西普玻璃体腔注射,对照组术前不给予康柏西普注射,两组均行相同的25G微创玻璃体切割手术治疗。观察比较两组患者手术时间、术中并发症和术后3个月最佳矫正视力(BCVA)差异。结果治疗组手术时间、术中出血数、术中电凝数、医源性视网膜损伤数、硅油填充数均显著少于对照组(P 0.05)。治疗组术后3个月BCVA显著优于对照组(P 0.05)。两组均无其他全身不良反应。结论术前7 d给予玻璃体腔注射康柏西普辅助治疗,能有效减少25G微创玻璃体切割术治疗PDR的手术时间和术中并发症,并改善术后视力。     

雷珠单抗对糖尿病增殖性视网膜病变患者玻璃体切割术的影响

目的 观察玻璃体腔内注射雷珠单抗对增殖性糖尿病视网膜病变（PDR）患者玻璃体切割术实施及预后的影响. 方法 选择PDR患者40例（45眼）,随机分为：试验组20例（22眼）玻璃体腔内注射雷珠单抗0.5 mg,行玻璃体切割术;对照组20例（23眼）直接行玻璃体切割术.分析两组术中、术后临床指标的差异. 结果 试验组平均手术持续时间、术中电凝止血频率及医源裂孔发生率均低于对照组[时间：（96±12）vs（133±15） min,P＜0.001;止血百分率：3（13.6％）vs9（39.1％）,P=0.038;裂空发生率：1（4.54％） vs 4（17.4％）,P=0.034].试验组术后1个月内前房和玻璃体腔积血率均较对照组降低[前房：1（4.54％）vs2（8.70％）,P=0.025;玻璃体腔：1（4.54％）vs3（13.0％）,P=0.048].两组术后视力均较术前提高,组间比较差异有统计学意义（P=0.020）. 结论 PDR患者在玻璃体切割术前注射雷珠单抗可缩短手术时间,减少术中出血及医源性裂孔的发生,减少术中术后并发症,获得更好的术后视力.     

Recovery of visual field defects following vitrectomy for proliferative diabetic retinopathy: A case report

Rationale:Proliferative diabetic retinopathy (PDR) may lead to severe visual impairment, and visual field (VF) loss in such patients has been reported. Vitrectomy is performed in PDR cases complicated with either vitreous hemorrhage or tractional retinal detachment to restore their visual acuity. However, its effect on VF defects is limited in data. Herein, we report the recovery of VF defects following vitrectomy in a patient with PDR.Patient concerns:A 25-year-old female with bilateral PDR and vitreous hemorrhage received 2 monthly intravitreal injections of aflibercept in both eyes. Six months after her last injection, she presented with fibrovascular membrane formation in both eyes and VF defects of −9.02 dB and −20.05 dB in the right and left eye, respectively.Diagnoses:Proliferative diabetic retinopathy in both eyes.Interventions:The patient underwent vitrectomy for her left eye.Outcomes:Although her visual acuity did not improve as expected, results from the Humphrey visual field analyzer showed notably improvement of her left eye (−9.05 dB) after the surgery.Lessons:Vitrectomy potentially allows recovery of VF defects in patients with PDR.     

双切口小梁切除联合超声乳化人工晶状体植入术治疗原发性闭角型青光眼合并白内障的效果分析

目的 分析双切口小梁切除联合超声乳化人工晶状体植入术治疗原发性闭角型青光眼合并白内障的临床效果.方法 回顾性分析2017年8月至2019年8月因原发性青光眼合并白内障在该院行手术治疗的112例患者的临床资料,根据手术方法不同分为观察组62例(67眼)和对照组50例(54眼),观察组实施双切口白内障超声乳化吸除+非球面人...     

老年白内障患者超声乳化吸除联合人工晶状体植入术后生存质量的变化

目的：探讨老年白内障患者超声乳化吸除联合人工晶状体植入术后生存质量的提高状况。方法：超声乳白内障化吸除联合人工晶状体植入术治疗的老年白内障患者116例，分别在手术前，手术后1周和1、3、6个月作眼科检查并完成生存质量问卷。结果：生存质量得分及自理，活动，社交和心理4个指标的得分在手术后1周和1、3、6个月4个时点比较，两两之间比较差异无显著性（P＞0．05），但术后4个时点均高于手术前得分，且差异有显著性（P＜0．05）。结论：老年性白内障患者在行白内障超声乳化吸除联合人工晶状体入术后1周，生存质量即提高，从术后1周至6个月，生存质量无明显变化。     

Long-term follow-up of patients who underwent yttrium-90 pituitary implantation for treatment of proliferative diabetic retinopathy

Summary Between 1960 and 1976 117 patients underwent pituitary implantation with yttrium-90 (⁹⁰Y) for treatment of proliferative retinopathy at the Hammersmith Hospital, London. Mean age at operation was 35±11 years (mean±SD), and mean duration of diabetes 18.6±10.0 years. Mean insulin dosage prior to implant was 67.2±24 units, falling to 30.4±14.9 units post-implant. Thirty-two per cent of patients are still living, 60% are deceased and 8% are lost to follow-up. The 5-year survival rate was 82%. Of the causes of death, 21% died of infection, adrenal insufficiency or hypoglycaemia, 12% of renal failure, and 47% of myocardial or cerebral vascular disease. Ophthalmological follow-up was carried out on the 100 patients operated on between 1965 and 1976. The mean age of this group at implant was 35±10.5 years, and mean duration of diabetes 17.2±8.7 years. Visual acuity in the better eye at operation was 6/12 or better in 84% of patients, and this percentage remained similar at the time of the 5 and 10 year follow-up. Blindness (6/60 or worse) in both eyes was present in 12% of patients at the time of 5 and 10 year assessments. By 5 years new vessels on the disc had improved from a mean grading of 2.7±1.6 to 0.8±1.2 (p<0.001), and by 10 years there was no disc neovascularisation in any eye. There was a similar improvement in the grading of hard exudates, microaneurysms and haemorrhages, but there was an increase in fibrous retinitis proliferans. It is concluded that pituitary ablation was an effective method of treating proliferative retinopathy, and may have had a beneficial effect on other microvascular complications.     

Long-term outcome after photocoagulation for proliferative diabetic retinopathy

One-hundred and forty patients with 182 treated eyes were followed for up to 10 years after photocoagulation for proliferative diabetic retinopathy. Sixty-eight patients were still alive and under review after 10 years. Mortality was 33% at 10 years and the survivors were younger when treated and had lower systolic and diastolic blood pressures, a lower urea and creatinine and a lower prevalence of proteinuria and ECG evidence of ischaemia at baseline. Sixty-nine percent of all patients and 82% of those followed up for 10 years maintained good vision (6/12 or better) in their better eye at the last follow-up. Visual deterioration occurred mostly in the first 2 years after treatment and risk factors for poor final vision were poor vision at baseline, severity of disc new vessels, and age at presentation. It is concluded that the short-term beneficial effect of photocoagulation is maintained over long periods of follow-up.     

Treatment of severe proliferative retinopathy and diabetic maculopathy

Strict blood glucose control, early detection and surveillance of diabetic retinopathy by means of validated screening programmes, and judicious use of laser photocoagulation can greatly reduce the risk of visual loss in diabetes. Some patients however, have aggressive neovascular disease resistant to laser treatment, or present at a late stage with advanced fibroproliferative disease, and may progress rapidly to blindness. In the elderly with Type 2 disease, diabetic maculopathy is more common and requires a different therapeutic approach. The present article describes two diabetic patients and discusses the management of patients with severe proliferative retinopathy or diabetic maculopathy.     

Angiogenic and antiangiogenic factors in proliferative diabetic retinopathy

Diabetic retinopathy continues to be the leading cause of legal blindness among working-age individuals. The earliest histological features of diabetic retinopathy include neuroretinal damage, capillary basement membrane thickening, loss of pericytes and loss of endothelial cells. At advanced stages, neovascularization, the hallmark of proliferative diabetic retinopathy (PDR) occurs, and blindness can result from relentless abnormal fibrovascular proliferation with subsequent bleeding and retinal detachment. Macular oedema is another retinal complication of diabetes that is responsible for a major part of vision loss, particularly in type 2 diabetes. The breakdown of the blood retinal barrier and the consequent vascular leakage and thickening of retina are the main events involved in its pathogenesis. Although a tight control of both blood glucose levels and hypertension are essential to prevent or arrest progression of the disease, the recommended goals are difficult to achieve in many patients. Laser photocoagulation treatment soon after the onset of PDR significantly reduces the incidence of severe vision loss. However, the optimal timing for laser treatment is frequently passed and, in addition, it is not uniformly successful in halting visual decline. For all these reasons, new pharmacological treatments based on the understanding of the pathophysiological mechanisms of diabetic retinopathy have been developed in recent years. There is mounting evidence to suggest that angiogenic factors play a crucial role in PDR development, vascular endothelial growth factor (VEGF) being the most relevant. Other growth factors or cytokines such as insulin-like growth factor I (IGF-1), hepatocyte growth factor (HGF), basic fibroblast growth factor (b-FGF), platelet derived growth factor (PDGF), pro-inflammatory cytokines and angiopoetins, are also involved in the pathogenesis of PDR. However, the intraocular synthesis of angiogenic factors is counterbalanced by the synthesis of antiangiogenic factors. Therefore, the balance between the angiogenic and antiangiogenic factors rather than angiogenic factors themselves will be crucial in determining the progression of PDR. The main antiangiogenic factor is the pigment epithelium derived factor (PEDF) but the transforming growth factor beta (TGF-beta), thrombospondin (TSP) and somatostatin are also among the intraocullary synthesized antiangiogenic factors.     

单一注射器气液交换法治疗增生性糖尿病视网膜病变玻璃体切除术后玻璃体再出血的疗效观察

目的 观察单一注射器气液交换法治疗增生性糖尿病视网膜病变玻璃体切除术后玻璃体再出血的疗效.方法 选择2019年1月至2020年12月广西医科大学第一附属医院收治的30例增生性糖尿病视网膜病变行玻璃体切除术后再出血患者的临床资料.患者均取坐位或俯卧位,以单一注射器行玻璃体腔气液交换术治疗.观察患者术后视力、晶状体、眼底和...     

Novel role of erythropoietin in proliferative diabetic retinopathy

Diabetic retinopathy is a leading cause of visual disturbance in adults. In proliferative diabetic retinopathy, ischemia-induced pathologic growth of new blood vessels often causes catastrophic loss of vision. Besides VEGF, the existence of another potent ischemia-induced angiogenic factor is postulated. Since ischemia-inducible erythropoietin (Epo) has recently been identified its angiogenic properties, we investigated its potential role during retinal angiogenesis in proliferative diabetic retinopathy (PDR). The vitreous Epo level in patients with PDR was significantly higher than that in nondiabetic patients. Multivariate logistic regression analyses indicated that Epo and VEGF were independently associated with PDR and that Epo was more strongly associated with PDR than VEGF. Blockade of Epo inhibits retinal neovascularization in vivo, and inhibits endothelial cell proliferation response to PDR vitreous in vitro. Our data provide strong evidence that erythropoietin is a potent retinal angiogenic factor independent of VEGF and is capable of stimulating ischemia-induced retinal angiogenesis in proliferative diabetic retinopathy. Inhibition of such molecular mechanisms in the retinal angiogenesis could be a new therapeutical strategy in halting or preventing pathologic angiogenesis in diabetic retinopathy.     

玻璃体切割、白内障摘除联合与分期手术对角膜内皮的影响

目的比较玻璃体切割、白内障摘除联合和分期手术对角膜内皮的影响。方法32例（32眼）患者,16例（16眼）行玻璃体切割联合自内障摘除术（联合手术组）,16例（16眼）行分期手术（分期手术组）。检测两组患者手术前后的角膜内皮细胞密度和六角形细胞。结果两组患者角膜内皮细胞密度手术前后及术后组间比较P均〉0．05;两组患者角膜内皮六角形细胞比例手术前后相比P均〈0．05,术后组间比较P〉0．05。结论联合和分期手术都会导致角膜内皮细胞的减少,改变角膜内皮细胞形态。联合与分期手术对角膜内皮的影响无明显差异。     

Clinical efficacy of intravitreal aflibercept injection versus vitrectomy with panretinal photocoagulation for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis

Background:In the current literature, it is still controversial whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) patients. Given that there is no high-quality meta-analysis or review to incorporate existing evidence, the purpose of this study is to systematically review the level I evidence in the literature to ascertain whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with PRP for PDR patients.Methods:The systematic literature review is structured to adhere to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), which include requirements deemed essential for the transparent reporting of results. A systematic search will be performed in Web of Science, Embase, Scopus, Science Direct, Cochrane Library up to and inclusive of March 19, 2021. The method of data extraction will follow the approach outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome is change in best-corrected visual acuity. The secondary outcomes are change in area of neovascularization and change in area of retinal nonperfusion. Where disagreement occurs, this will be resolved through discussion. All outcomes are pooled on random-effect model. A P value of < .05 is considered to be statistically significant.Results:The results of our review will be reported strictly following the PRISMA criteria.Conclusions:The hypothesis of the study was that visual acuity recovery would be faster with vitrectomy because the blood is mechanically cleared during surgery.Registration number:10.17605/OSF.IO/NCAXW.