增生型糖尿病视网膜病变患眼抗血管内皮生长因子药物联合玻璃体切割手术后玻璃体再积血的相关危险因素分析

目的观察分析增生型糖尿病视网膜病变(PDR)患眼抗VEGF药物联合玻璃体切割手术(PPV)后玻璃体再积血(PVH)的相关危险因素。方法回顾性分析研究。2017年4月至2018年7月在嘉兴市眼科医院确诊并接受抗VEGF药物联合25G PPV治疗的87例PDR患者100只眼纳入研究。其中,男性38例44只眼,女性49例56只眼。年龄26~83岁,平均年龄(57.72±8.82)岁。所有患者对象均为2型糖尿病,平均糖尿病病程(10.84±6.03)年。所有患眼均由同一位医生在非接触广角镜辅助下行标准经睫状体平坦部三通道25G PPV。手术前5~7 d按内眼手术操作方法行玻璃体腔注射10 mg/ml的雷珠单抗或康柏西普0.05 ml(含雷珠单抗或康柏西普0.5 mg)治疗。观察患眼的PVH发生率。对比分析是否发生PVH者年龄、糖尿病病程、手术前视力、手术前空腹血糖及餐后血糖、手术前收缩压及舒张压水平、手术前是否接受过激光治疗、手术中是否摘除晶状体、手术中是否给予眼内填充物、手术中视网膜激光点数以及手术中眼底病变(增生膜、视网膜出血、血管闭塞、增生视网膜牵引、视网膜裂孔、视网膜脱离、渗出、新生血管)等情况。分析抗VEGF药物联合PPV治疗PDR后发生PVH的相关危险因素。对数据进行Spearman双变量相关性分析及二元logistic回归分析。结果87例100只眼中,发生PVH 15例17只眼,占患眼的17%;未发生PVH 72例83只眼,占患眼的83%。发生与未发生PVH者手术中发现血管闭塞以及增生视网膜牵引的眼数比较,差异均有统计学意义(χ^2=5.741、8.103,P<0.05);年龄(t=-1.364)、糖尿病病程(t=0.538)、手术前视力(t=1.897)、手术前空腹血糖(t=1.938)、手术前餐后血糖(t=1.508)、手术前收缩压(t=-0.571)、舒张压水平(t=0.275)、手术前是否接受激光治疗(χ^2=2.678)、手术中激光点数(t=0.565)、手术中是否摘除晶状体(χ^2=0.331)、手术中发现新生血管(χ^2=2.741)及手术中是否给予填充物(χ^2=0.060)等情况比较,差异均无统计学意义(P>0.05)。Spearman双变量相关性分析结果显示,手术前患者视力低下、空腹血糖水平控制差以及手术中见血管闭塞、增生视网膜牵引是PVH发生的相关危险因素(rs=0.208、0.229、0.240、0.285,P<0.05)。二元logistic回归分析结果显示,手术中见眼底血管闭塞、增生视网膜牵引可能是PVH发生的独立危险因素(OR=5.175、13.915,P<0.05)。结论PPV中可见的眼底血管闭塞、纤维血管膜增生导致的视网膜牵引可能是PDR患者抗VEGF药物联合PPV后PVH发生的独立危险因素。

Analysis of related risk factors of vitreous hemorrhage after anti-vascular endothelial growth factor combined with vitrectomy for proliferative diabetic retinopathy

Objective To observe and analyze the risk factors related to vitreous re-hemorrhage(PVH)after anti-VEGF drugs combined with vitrectomy(PPV)in patients with proliferative diabetic retinopathy(PDR).Methods Retrospective analysis study.From April 2017 to July 2018,100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study.Among them,there were 44 eyes in 38 males and 56 eyes in 49 females.The age ranged from 26 to 83 years,with an average age of 57.72±8.82 years.All patients were type 2 diabetes,with an average duration of diabetes 10.84+6.03 years.All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body.Five to 7 days before the operation,intravitreal injection of ranibizumab or conbercept 0.05 ml(10 mg/ml)was performed.The incidence of PVH was observed.The age of PVH patients,duration of diabetes,vision before operation,average fasting blood glucose and average postprandial blood glucose before operation,systolic blood pressure and diastolic blood pressure before surgery,laser treatment before surgery,lens removal during operation,intraocular filling during operation,retinal laser points during operation,and fundus lesions during operation(hyperplasia film,Retinal hemorrhage,vascular occlusion,proliferative retinal traction,retinal hiatus,retinal detachment,exudation,neovascularization)were analyzed to find out the cause of PVH.Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data.Results Of the 100 eyes of 87 patients,PVH occurred in 17 eyes(17%).There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH(χ^2=5.741,8.103;P<0.05).There was no significant difference in age(t=-1.364),duration of diabetes(t=0.538),preoperative vision(t=1.897),preoperative fasting blood glucose level(t=1.938),preoperative postprandial blood glucose level(t=1.508),preoperative systolic blood pressure(t=-0.571),preoperative diastolic blood pressure(t=0.275),whether received laser treatment(χ^2=2.678),the number of laser points during operation(t=0.565),whether received lens removal during operation(χ^2=0.331),whether found new blood vessels during operation(χ^2=2.741)and whether received intraocular filling during operation(χ^2=0.060)between the patients with and without PVH(P>0.05).Spearman's bivariate correlation analysis showed that patients with low vision,poor control of fasting blood glucose levels,vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH(rs=0.208,0.229,0.240,0.285;P<0.05).Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery(OR=5.175,13.915;P<0.05).Conclusion Fundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV.