23G玻璃体切割术治疗增生型糖尿病视网膜病变术后早期出血的危险因素分析

目的：探讨增生型糖尿病视网膜病变（PDR）经23G玻璃体切割术后发生早期术后玻璃体积血（PVH）的可能危险因素。方法：回顾性病例对照研究。收集2014 年1 月至2016 年12 月在中国中医科学院眼科医院行23G玻璃体切割术的PDR患者69 例（69 眼），根据有无术后早期PVH将其分为早期PVH组（19 例）和无早期PVH组（50 例），分析人口学资料、全身疾病及眼部情况。采用t检验或χ2 检验比较2 组临床特征，采用Logistic回归分析发生早期PVH的可能危险因素。结果：早期PVH的发生率为28%，该组平均年龄（49.6 ± 8.7）岁；无早期PVH组平均年龄（57.3 ± 10.0）岁，早期PVH组年龄较小（t=-2.969，P=0.040），而其他全身因素差异无统计学意义。早期PVH组和无早期PVH组眼部因素中晶状体状态（χ2=3.933，P=0.047），术前是否玻璃体腔注射抗血管内皮生长因子药物（χ2=4.784，P=0.029），眼底是否有纤维血管膜增殖（χ2=8.180，P=0.004），术中是否发生视盘新生血管出血（χ2=11.147，P=0.001）等差异有统计学意义；其他眼部因素差异无统计学意义。Logistic回归分析显示视盘新生血管出血、纤维血管膜增殖OR值分别为6.249（P=0.012）、4.833（P=0.028）。结论：23G玻璃体切割术后早期PVH主要发生在眼底病变严重的PDR患者，视盘新生血管出血和纤维血管膜增殖会增加术后早期PVH的风险。

Risk Factors for Early Postoperative Vitreous Hemorrhage after 23-gauge Vitrectomy for Proliferative Diabetic Retinopathy

Objective:To identify the potential risk factors for proliferative diabetic retinopathy (PDR) in cases with early postoperative vitreous hemorrhage (PVH) after 23-gauge vitrectomy.Methods:In this case-controlled study,the medical records of 69 eyes of 69 consecutive PDR patients who underwent primary 23-gauge vitrectomy During January 2014 to December 2016 at Eye Hospital,China Academy of Chinese Medical Sciences were reviewed.The eyes were divided into two groups,one with early PVH (19 cases) and the other without it (50 cases).Demographic data and ocular and systemic parameters were analyzed.Differences between the two groups in the clinical characteristics of the ocular and systemic factors were determined using t-tests or chi-square tests.Risk factors for development of early PVH were determined by Logistic regression analysis.Results:The overall incidence of early PVH was 28％ (19/69 eyes).The mean±standard deviation age of the patients with and without early PVH were 49.6±8.7 years and 57.3±10.0 years respectively (t=-2.969,P=0.040).There were no significant differences in any of the other systemic factors.The values for the early PVH group were all greater than for the non-early PVH group for the following parameters:lens status (crystalline lens/intraocular lens) (x2=3.933,P=0.047),preoperative intravitreal anti-vascular endothelial growth factor injection (x2=4.784,P=0.029),fibrovascular membrane proliferation (x2=8.180,P=0.004),and intraoperative bleeding from new vessels on the disc (x2=11.147,P=0.001).There were no significant differences in other ocular factors.The risk factors associated with the incidence of early PVH were bleeding from new vessels on the disc (OR=6.249,P=0.012) and fibrovascular membrane proliferation (OR=4.833,P=0.028).Conclusions:Early PVH after 23-gauge vitrectomy tends to occur in severe PDR cases.Bleeding from new vessels on the disc and fibrovascular membrane proliferation increase the risk of early PVH.