[1]郑新宝,陈佳玉,魏嘉洪,等.个性化玻璃体切割术治疗增生型糖尿病视网膜病变的临床效果[J].眼科新进展,2024,44(6):449-453.[doi:10.13389/j.cnki.rao.2024.0087]
 ZHENG Xinbao,CHEN Jiayu,WEI Jiahong,et al.Clinical effect of personalized pars plana vitrectomy for proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2024,44(6):449-453.[doi:10.13389/j.cnki.rao.2024.0087]
点击复制

个性化玻璃体切割术治疗增生型糖尿病视网膜病变的临床效果/HTML
分享到:

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
44卷
期数:
2024年6期
页码:
449-453
栏目:
应用研究
出版日期:
2024-06-03

文章信息/Info

Title:
Clinical effect of personalized pars plana vitrectomy for proliferative diabetic retinopathy
作者:
郑新宝陈佳玉魏嘉洪夏静杨爱萍陈春峰李明芳冯成赵永旺张敬法
201600 上海市,上海交通大学医学院附属松江医院(郑新宝,陈佳玉,魏嘉洪,夏静,杨爱萍,陈春峰,李明芳,冯成,赵永旺);200080 上海市,上海市第一人民医院眼科(张敬法)
Author(s):
ZHENG Xinbao1CHEN Jiayu1WEI Jiahong1XIA Jing1YANG Aiping1CHEN Chunfeng1LI Mingfang1FENG Cheng1ZHAO Yongwang1ZHANG Jingfa2
1.Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 201600,China
2.Department of Ophthalmology,Shanghai General Hospital (Shanghai First People’s Hospital),Shanghai 200080,China
关键词:
个性化玻璃体切割术增生型糖尿病视网膜病变手术时间最佳矫正视力手术并发症
Keywords:
personalized pars plana vitrectomy proliferative diabetic retinopathy operation time best corrected visual acuity surgical complications
分类号:
R774
DOI:
10.13389/j.cnki.rao.2024.0087
文献标志码:
A
摘要:
目的 观察个性化玻璃体切割术(PPV)治疗增生型糖尿病视网膜病变(PDR)的临床效果。
方法 回顾性病例研究。纳入2019年10月至2022年11月在上海交通大学医学院附属松江医院眼科确诊为PDR并接受PPV治疗的患者76例(86眼),分为观察组40例(46眼)和对照组36例(40眼)。观察组采取个性化PPV,对照组采用传统PPV。进行12个月随访观察,比较2组患者手术时间,术中重水、硅油使用率,医源性视网膜裂孔、视网膜下重水残留发生率,巩膜外加压比例,手术前后不同时间最佳矫正视力(BCVA)、眼压,术后12个月视网膜复位率以及玻璃体内再积血(PVH)、糖尿病黄斑水肿(DME)和新生血管性青光眼(NVG)等发生率。
结果 观察组患者手术时间比对照组短(P<0.05)。观察组患者术中重水、硅油使用率均比对照组低(均为P<0.05)。2组患者术中医源性视网膜裂孔、视网膜下重水残留发生率和行巩膜外加压比例比较差异均无统计学意义(均为P>0.05)。2组患者术前、术后3个月、术后6个月、术后12个月BCVA差异均无统计学意义(P>0.05)。术后1 d、1周、1个月,观察组患者BCVA均优于对照组(均为P<0.05);与术前比较,术后1 d、1周、1个月、3个月、6个月、12个月观察组患者BCVA均提高(均为P<0.05);对照组术后1 d、1周BCVA提高均不明显(均为P>0.05),术后1个月、3个月、6个月、12个月BCVA均提高(均为P<0.05)。2组患者术后1 d、1周、1个月、3个月、6个月、12个月眼压比较差异均无统计学意义(均为P>0.05)。术后12个月,2组患者视网膜复位率以及PVH、DME和NVG等并发症发生率差异均无统计学意义(均为P>0.05)。
结论 个性化PPV手术可以缩短手术时间,减少术中重水、硅油使用率,提高手术效率,快速提升PDR患者视力。
Abstract:
Objective To explore the clinical effect of personalized pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR).
Methods In this retrospective case study, 76 patients (86 eyes) diagnosed with PDR and receiving PPV in the Department of Ophthalmology of Songjiang Hospital affiliated to Shanghai Jiao Tong University School of Medicine, from October 2019 to November 2022, were divided into the observation group (40 patients, 46 eyes) and the control group (36 patients, 40 eyes).Patients in the obseration group were treated with personalized PPV, while patients in the control group were treated with conventional PPV, After treatment, all patients were followed up for 12 months.The operation time, intraoperative use of heavy water and silicone oil, incidence of iatrogenic retinal tears and heavy water residues, proportion of scleral buckling, preoperative and postoperative best corrected visual acuity (BCVA) and intraocular pressure (IOP), retinal reattachment rate at 12 months after surgery, and the incidence of post-vitrectomy vitreous hemorrhage (PVH), diabetic macular edema (DME) and neovascular glaucoma (NVG) were compared between the two groups.
Results The operation time of patients in the observation group was shorter than that in the control group (P<0.05). Intraoperative use of heavy water and silicone oil in the observation group was lower than that in the control group (both P<0.05). The incidence of iatrogenic retinal tears and heavy water residues and the proportion of scleral buckling showed no statistically significant difference between the two groups (all P>0.05). There was no statistically significant difference between the two groups in BCVA preoperatively, 3, 6 and 12 months postoperatively (all P>0.05). BCVA in the observation group was better than that in the control group at 1 day, 1 week and 1 month after surgery (all P<0.05). Compared with the preoperative value, BCVA increased in the observation group at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery (all P<0.05); in the control group, BCVA increased slightly at 1 day and 1 week (both P>0.05) and then increased significantly at 1 month, 3 months, 6 months, and 12 months after surgery (all P<0.05). The two groups showed no statistically significant difference in IOP at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively (all P>0.05). There was no statistically significant difference in the retinal reattachment rate and the incidence of complications such as PVH, DME, and NVG between the two groups at 12 months postoperatively (all P>0.05).
Conclusion Personalized PPV can shorten the operation time, reduce the intraoperative use of heavy water and silicone oil, enhance the efficiency of the operation, and rapidly improve the visual acuity of PDR patients.

参考文献/References:

[1] CHO N H,SHAW J E,KARURANGA S,HUANG Y,DA ROCHA FERNANDES J D,OHLROGGE A W,et al.IDF Diabetes atlas:global estimates of diabetes prevalence for 2017 and projections for 2045[J].Diabetes Res Clin Pract,2018,138:271-281.
[2] BLONDE L,UMPIERREZ G E,REDDY S S,MCGILL J B,BERGA S L,BUSH M,et al.American association of clinical endocrinology clinical practice guideline:developing a diabetes mellitus comprehensive care plan-2022 update[J].Endocr Pract,2022,28(10):923-1049.
[3] SUN H,SAEEDI P,KARURANGA S,PINKEPANK M,OGURTSOVA K,DUNCAN B B,et al.IDF diabetes atlas:global,regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J].Diabetes Res Clin Pract,2022,183:109119.
[4] NOURELDINE A M,ABDELMAKSOUD A M S,MOSTAFA H A A F,MACKY T,ELBOHY A E.Orbital blood vessels changes on color duplex imaging in diabetics with and without diabetic retinopathy[J].Sci Rep,2023,13(1):17115.
[5] LI Y,TENG D,SHI X,QIN G,QIN Y,QUAN H,et al.Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association:national cross sectional study[J].BMJ,2020,369:m997.
[6] WUBBEN T J,JOHNSON M W,GROUP A V T I S.Anti-vascular endothelial growth factor therapy for diabetic retinopathy:consequences of inadvertent treatment interruptions[J].Am J Ophthalmol,2019,204:13-18.
[7] WANG L,GAO P,ZHANG M,HUANG Z,ZHANG D,DENG Q,et al.Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.
[8] ZHAO X Y,XIA S,CHEN Y X.Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy:a meta-analysis of randomised controlled trials[J].Br J Ophthalmol,2018,102(8):1077-1085.
[9] 王默,廖欣,谢春蕾,汪浩,王方.不同时间玻璃体注射雷珠单抗辅助玻璃体切割手术治疗增生性糖尿病视网膜病变的疗效观察[J].中华眼底病杂志,2016,32(3):300-305.
WANG M ,LIAO X ,XIE C L,WANG H ,WANG F.Observation on the efficacy of vitreous injection of ranibizumab at different times to assist vitrectomy in the treatment of proliferative diabetic retinopathy[J].Chin J Ocul Fundus Dis,2016,32(3):300-305.
[10] 郑传珍,任新军,柯屹峰,温德佳,李筱荣.最小量化玻璃体切除术治疗严重增生性糖尿病视网膜病变的初步观察[J].中华眼科杂志,2021,57(6):440-446.
ZHENG C Z,REN X J,KE Y F,WEN D J,LI X R.Minimally invasive vitrectomy for the treatment of severe proliferative diabetic retinopathy[J].Chin J Ophthalmol,2021,57(6):440-446.
[11] 夏静,陈佳玉,杨爱萍,王莉,赵永旺.25G+PPV联合术前玻璃体腔注射康柏西普治疗增生型糖尿病视网膜病变[J].国际眼科杂志,2023,9(2):294-298.
XIA J,CHEN J Y,YANG A P,WANG L,ZHAO Y W.Effect of 25G+pars Plana vitrectomy combined with preoperative intravitreal injection of Conbercept on proliferative diabetic retinopathy[J].Int Eye Sci,2023,9(2):294-298.
[12] SCHULZE-BONSEL K,FELTGEN N,BURAU H,HANSEN L,BACH M.Visual acuities “hand motion” and “counting fingers” can be quantified with the Freiburg visual acuity test[J].Invest Ophthalmol Vis Sci,2006,47(3):1236-1240.
[13] 郑新宝,陈佳玉,夏静,杨爱萍,李明芳,陈春峰,等.自制玻璃体气液交换装置在增生期糖尿病视网膜病变患者玻璃体切术后玻璃体腔积血的临床应用[J].临床眼科杂志,2023,31(4):305-310.
ZHENG X B,CHEN J Y,XIA J,YANG A P,LI M F,CHEN C F,et al.Clinical application of self-made vitreous gas-liquid exchange device in vitreous cavity blood accumulation after vitrectomy in patients with proliferative stage of diabetic retinopathy[J].J Clin Ophthalmol,2023,31(4):305-310.
[14] NEWMAN D K.Surgical management of the late complications of proliferative diabetic retinopathy[J].Eye,2010,24(3):441-449.
[15] AREVALO J F,MAIA M,FLYNN H W Jr,SARAVIA M,AVERY R L,WU L,et al.Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy[J].Br J Ophthalmol,2008,92(2):213-216.
[16] SCHREY S,KREPLER K,WEDRICH A.Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients[J].Retina,2006,26(2):149-152.
[17] SATO T,TSUBOI K,NAKASHIMA H,EMI K.Characteristics of cases with postoperative vitreous hemorrhage after 25-gauge vitrectomy for repair of proliferative diabetic retinopathy[J].Graefes Arch Clin Exp Ophthalmol,2017,255(4):665-671.
[18] LIANG X,ZHANG Y,WANG J X,WANG L F,HUANG W R,TANG X.Intravitreal ranibizumab injection at the end of vitrectomy for diabetic vitreous hemorrhage (Observational Study)[J].Medicine,2019,98(20):e15735.

相似文献/References:

[1]衡欣 陈悦.增生型糖尿病视网膜病变患者血清中转化生长因子-β1和结缔组织生长因子水平的变化及意义[J].眼科新进展,2013,33(4):000.
[2]赵新荣,杨炜,邱明磊,等.玻璃体内注射雷珠单抗联合玻璃体切割术治疗严重增生型糖尿病视网膜病变[J].眼科新进展,2015,35(11):1064.[doi:10.13389/j.cnki.rao.2015.0291]
 ZHAO Xin-Rong,YANG Wei,QIU Ming-Lei,et al.Ranibizumab injection and vitrectomy for severe proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2015,35(6):1064.[doi:10.13389/j.cnki.rao.2015.0291]
[3]刘建伟,李聪伶,于海群.雷珠单抗玻璃体内注射对增生型糖尿病视网膜病变玻璃体切割术效果的影响[J].眼科新进展,2016,36(3):265.[doi:10.13389/j.cnki.rao.2016.0071]
 LIU Jian-Wei,LI Cong-Ling,YU Hai-Qun.Effects of intravitreal injection of ranibizumab on vitrectomy for proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2016,36(6):265.[doi:10.13389/j.cnki.rao.2016.0071]
[4]饶玉萍,徐玲娟,肖紫云,等.增生型糖尿病视网膜病变患者血浆和玻璃体中VEGF和低密度脂蛋白受体相关蛋白6的表达及其相关性[J].眼科新进展,2016,36(3):278.[doi:10.13389/j.cnki.rao.2016.0075]
 RAO Yu-Ping,XU Ling-Juan,XIAO Zi-Yun,et al.Expression and correlation of LRP6 and VEGF in plasma and vitreous of PDR patients[J].Recent Advances in Ophthalmology,2016,36(6):278.[doi:10.13389/j.cnki.rao.2016.0075]
[5]孙丽丽,季拓.贝伐单抗联合全视网膜光凝治疗增生型糖尿病视网膜病变的疗效观察[J].眼科新进展,2016,36(10):949.[doi:10.13389/j.cnki.rao.2016.0254]
 SUN Li-Li,JI Tuo.Effects of bevacizumab combined with panretinal photocoagulation on proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2016,36(6):949.[doi:10.13389/j.cnki.rao.2016.0254]
[6]韩治华,杨淑焕,郭卫民,等.TGF-β介导的Smad信号通路在增生型糖尿病视网膜病变中的作用和意义[J].眼科新进展,2016,36(10):957.[doi:10.13389/j.cnki.rao.2016.0256]
 HAN Zhi-Hua,YANG Shu-Huan,GUO Wei-Min,et al.Role and significance of TGF-β mediated Smad signaling pathways in proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2016,36(6):957.[doi:10.13389/j.cnki.rao.2016.0256]
[7]石兴东,李文博,马腾,等.玻璃体切割手术治疗增生型糖尿病视网膜病变的疗效观察[J].眼科新进展,2017,37(3):248.[doi:10.13389/j.cnki.rao.2017.0062]
 SHI Xing-Dong,LI Wen-Bo,MA Teng,et al.Effects of vitrectomy on proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2017,37(6):248.[doi:10.13389/j.cnki.rao.2017.0062]
[8]丁国龙,谢安明,雷剑琴,等.增生型糖尿病视网膜病变患者玻璃体内注射贝伐单抗后房水中细胞因子的变化及其相关性分析[J].眼科新进展,2017,37(4):358.[doi:10.13389/j.cnki.rao.2017.0091]
 DING Guo-Long,XIE An-Ming,LEI Jian-Qin,et al.Changes of cytokines in aqueous humor of patients with proliferative diabetic retinopathy after intravitreal bevacizumab and their correlation analysis[J].Recent Advances in Ophthalmology,2017,37(6):358.[doi:10.13389/j.cnki.rao.2017.0091]
[9]杨苗苗,王帅,王文战.1型与2型糖尿病并发增生型糖尿病视网膜病变患者的眼生物学测量值比较[J].眼科新进展,2017,37(4):362.[doi:10.13389/j.cnki.rao.2017.0092]
 YANG Miao-Miao,WANG Shuai,WANG Wen-Zhan.Comparison of ocular biological measurements between type 1 and type 2 diabetic patients with proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2017,37(6):362.[doi:10.13389/j.cnki.rao.2017.0092]
[10]薛鹏程,游志鹏,付书华,等.23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普治疗增生型糖尿病视网膜病变(PDR)的疗效分析[J].眼科新进展,2017,37(5):458.[doi:10.13389/j.cnki.rao.2017.0116]
 XUE Peng-Cheng,YOU Zhi-Peng,FU Shu-Hua,et al.Preoperative and intraoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2017,37(6):458.[doi:10.13389/j.cnki.rao.2017.0116]

备注/Memo

备注/Memo:
国家自然科学基金面上项目(编号:82171062);上海市松江区公共卫生协同能力提升项目(编号:SJGW6-24)
更新日期/Last Update: 2024-06-05