糖尿病视网膜病变玻璃体切除术后发生新生血管性青光眼的因素分析

目的：探讨增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)在行玻璃体切除术治疗后发生新生血管性青光眼(neovascular glaucoma，NVG)的因素。

方法：回顾性分析2013-01/2017-12于我院就诊因PDR行玻璃体切除术治疗患者(233例237眼)的临床资料，分为NVG组和非NVG组，分析患者术后发生NVG的相关因素。

结果：所有患者中，未发生NVG组217眼。发生NVG者共20例20眼，12眼联合白内障手术，其中6眼晶状体后囊膜缺失或不完整； 14眼合并有高血压； 16眼合并有高血脂症； 6眼再次行PPV术； 2眼为硅油填充眼或者已行硅油移除眼。玻璃体切除术中联合白内障手术合并晶状体后囊膜不完整与PDR手术后发生 NVG有相关性； 玻璃体腔硅油填充一定程度上可能对发生NVG起到抑制作用。高血压、高血脂、再次PPV术与PDR术后发生 NVG无相关性。

结论：正确把握晶状体手术时机、恰当选择玻璃体腔填充物对预防PDR术后发生 NVG具有积极意义。

Clinical analysis of neovascular glaucoma after vitrectomy in patients with diabetic retinopathy

AIM: To explore the factors and analyze the occurrence of neovascular glaucoma(NVG)after vitrectomy for proliferative diabetic retinopathy(PDR).

METHODS:Retrospective analysis on the clinical materials from January 2013 to December 2017, including 233 PDR patients(237 eyes)treated with vitrectomy in which 20 patients(20 eyes)occurred NVG after vitrectomy surgeries. The factors might lead to NVG were investigated.

RESULTS: Totally 20 patients(20 eyes)developed NVG, in which there were 12 eyes combined with cataract surgeries, of the 12 eyes, 6 eyes had posterior lens capsule deficiency; 14 eyes complicated with hypertensions; 16 eyes complicated with hyperlipoidemia; 6 eyes had reoperations of vitrectomy surgeries; 2 eyes were silicone oil-filled eyes or silicone oil-removed eyes. There were correlations between the combinations of the cataract surgeries, posterior lens capsule deficiency, and vitrectomy with the occurrences of NVG after PDR surgeries; vitreous silicone oil filling might inhibit the occurrence of NVG to a certain extent. There was no statistical significance in hypertensions, high plasma lipids and reoperations of vitrectomy surgery for occurrence of NVG after PDR surgery.

CONCLUSION: There is positive significance in correctly grasping the timing of lens surgery, and properly selecting the vitreous cavity filler.