ObjectiveTo investigate the risk factors of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy (PDR).MethodsFrom June 2015 to June 2017, 103 eyes of 103 patients with PDR diagnosed and underwent minimalvitrectomy in Henan Provincial People's Hospital were enrolled in the study. There were 58 males and 45 females, with the average age of 58.37±10.14 years and diabetes duration of 8.7±7.2 years. Baseline systemic parameters including sex, age, diabetes duration, hypertension, HbA1c, creatinine, whether received anticoagulants, ocular parameters including whether combined with vitreous hemorrhage, whether finished panretinal photocoagulation (PRP), whether received treatment of anti-VEGF, whether combined with iris neovascularization (NVI), lens status preoperatively, whether hypotony postoperatively and intraoperative parameters including whether disc neovascularization (NVD) bleeding, whether fibrovascular membrane (FVM) residual, laser points, whether combined with cataract phacoemulsification were identified by multivariate logistic regression analysis.ResultsTwenty-nine of 103 eyes (28.15%) developed PVH in 1 day to 6 months after surgery, with self absorption of 18 eyes and reoperation of 11 eyes. Univariate analysis showed there were significant differences in age (t=2.124, P=0.036), anti-VEGF(χ2=7.105, P=0.008), NVD bleeding (χ2=10.158, P=0.001) and FVM residual(χ2=8.445, P=0.004) between patients with and without postoperative vitreous hemorrhage. Sex (χ2=0.021, P=0.884), diabetes duration (t=0.87, P=0.386), hypertension (χ2=2.004, P=0.157), HbA1c (t=1.211, P=0.229), creatinine (t=0.851, P=0.397), preoperative oral anticoagulants (χ2=0.985, P=0.321), preoperative vitreous hemorrhage (χ2=0.369, P=0.544), PRP (χ2=1.122, P=0.727), NVI (χ2=2.635, P=0.105), lens status (χ2=0.172, P=0.679), hypotony postoperatively (χ2=1.503, P=0.220), laser points (χ2=1.391, P=0.238) and combined phacoemulsification surgery (χ2=0.458, P=0.499) were not associated with PVH. Multivariate logistic regression analysis revealed the more PVH appeared in younger (OR=1.065, P=0.009) and NVD bleeding (OR=6.048, P=0.001) patients.ConclusionYounger age and NVD bleeding are the important risk factors for PVH after minimal vitrectomy without endotamponade in PDR.
ObjectiveTo compare the effects of intravitreal tamponade of C3F8 with silicon oil on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy (PDR). MethodsThe clinical data of 121 patients (127 eyes) who underwent primary vitrectomy due to PDR were analyzed retrospectively. All the patients were divided into two groups according to different intravitreal tamponade, including C3F8 tamponade group (53 patients with 56 eyes) and silicone oil tamponade group (68 patients with 71 eyes). There was no difference of gender (χ2=0.956), age (t=1.122), duratiion of diabetes (t=0.627), fasting blood glucose (t=1.049), systolic pressure (t=1.056), diastolic pressure (t=0.517), history of hypertension (χ2=0.356), nephropathy (χ2=1.242), preoperative laser photocoagulation (χ2=1.225) and All the patients underwent three port pars plana vitrectomy. The mean follow-up was 2 years ranging from 6 months to 4 years. And then the incidence and onset time of postoperative vitreous hemorrhage and postoperative BCVA of the two groups were compared. ResultsPostoperative vitreous hemorrhage occurred in 14 of 56 eyes (25.00%) in C3F8 tamponade group. The average onset time of postoperative vitreous hemorrhage were (64.64±59.09) days ranging from 7-225 days and mostly were within 30-60 days (35.71%, 5/14). Postoperative vitreous hemorrhage also occurred in 7 of 71 eyes (9.89%) of silicone oil tamponade group after silicone oil removal with an average onset time of (25.29±20.46) days ranging from 3-65 days and were mostly within 15-30 days (42.86%, 3/7). There was a significant difference in the incidence of postoperative vitreous hemorrhage between the two groups (χ2=5.200, P<0.05). BCVA of the two groups was improved significantly after operation (Z=2.472, 3.114; P<0.05). Postoperative BCVA of silicone oil tamponade group was poorer than C3F8 tamponade group (Z=1.968, P<0.05). ConclusionBoth C3F8 and silicone oil tamponade can improve the visual acuity after vitrectomy for PDR. Compared with C3F8, silicone oil tamponade had lower incidence and late onset of postoperative vitreous hemorrhage after vitrectomy for PDR.
ObjectiveTo observe the clinical effect of intravitreal ranibizumab (IVR) combined with vitrectomy in treating proliferative diabetic retinopathy (PDR). MethodsThis is a prospective non-randomized controlled clinical study. A total of 62 patients (70 eyes) who underwent vitrectomy for PDR were enrolled and divided into IVR group (30 patients, 34 eyes) and control group (32 patients, 36 eyes).IVR group patients received an intravitreal injection of 0.05 ml ranibizumab solution (10 mg/ml) 3 or 5 days before surgery. The follow-up time was 3 to 18 months with an average of (4.5±1.8) months. The surgical time, intraoperative bleeding, iatrogenic retinal breaks, use of silicone oil, the best corrected visual acuity (BCVA) and the incidence of postoperative complications were comparatively analyzed. ResultsThe difference of mean surgical time (t=6.136) and the number of endodiathermy during vitrectomy (t=6.128) between IVR group and control group was statistically significant (P=0.000, 0.036). The number of iatrogenic retinal break in IVR group is 8.8% and control group is 27.8%, the difference was statistically significant (χ2=4.154, P=0.032). Use of silicone oil of IVR group is 14.7% and control group is 38.9%, the difference was statistically significant (χ2=5.171, P=0.023). The incidence of postoperative vitreous hemorrhage in 3 month after surgery was 11.8% and 30.6% respectively in IVR group and control group. The differences were statistically significant (χ2=3.932, P=0.047). The 6 month postoperative mean BCVA of IVR group and control group have all improved than their preoperative BCVA, the difference was statistically significant (t=4.414, 8.234; P=0.000).But there was no difference between the mean postoperative BCVA of two groups (t=0.111, P=0.190). There was no topical and systemic adverse reactions associated with the drug after injection in IVR group. ConclusionsMicroincision vitreoretinal surgery assisted by IVR for PDR shorten surgical time, reduces the intraoperative bleeding and iatrogenic retinal breaks, reduces the use of silicon oil and the postoperative recurrent vitreous hemorrhage. But there was no significant relationship between vision improvement and IVR.
Objective To evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with diabetic tractional retinal detachment (DTRD). Methods The clinical interventional caseseries study included 104 patients (112 eyes) with DTRD, who were consecutively treated by pars plana vitrectomy without use of intraocular silicone oil or gas. Among the eyes, there were 6 eyes with iris neovascularization (INV), 1 eye with neovascular glaucoma (NVG) and 50 eyes with macular retinal detachment. There were no preexisting retinal holes or breaks prior to surgery nor any iatrogenic retinal breaks developed during vitrectomy. Cataract removal combined with intraocular lens implant surgeries were performed on 15 eyes. Followup duration varied from 12 to 65 months (mean: 29 months). Results Subretinal fluid was completely absorbed within 2 months after surgery. In 107 eyes (95.54%), the retina reattached after surgery and remained attached till the end of followup period. Best corrected visual acuity (BCVA) improved in 79 eyes (70.53%), remained unchanged in 14 eyes (12.50%) and got worse in 19 eyes (16.79%). The BCVA improving rate was lower in the macular detached group (33 eyes/50 eyes, 66.00% Vs 46 eyes/62 eyes, 74.19%,chi;2=0.89, P=0.344). No obviously aggravated opacity of lens was observed after vitreoretinal surgeries in the eyes without cataract surgeries. Seven (6.25%) eyes showed INV (5 new onset eyes), and none of them developed into NVG. In multivariate logistic regression, factors associated with postoperative rubeosis iridis were pre-existing rubeosis iridis ［adjusted odds ratio (OR)=10.2］, low preoperative BCVA (OR=11.1) and low postoperative BCVA (OR=16.7). Conclusions Vitreoretinal surgery for DTRD may not necessarily be combined with silicone oilor gas tamponade if there are no preoperative or intraoperative retinal breaks, and only using irrigation fluid could access a good longterm prognosis result.
ObjectiveTo observe the clinical effect of small-gauge vitrectomy (SGV) treatment for proliferative diabetic tractional (PDR) with retinal detachment (TRD). MethodsThe data of 42 patients (50 eyes) with PDR combined with TRD who had received SGV treatment were retrospectively analyzed. There were 22 males and 20 females, with an average age of (44.5±11.2) years. There were 16 eyes with TRD involving the macular area, 34 eyes without TRD involving the macular area. The eyes with rhegmatogenous retinal detachment or retinal hole were excluded. The best corrected visual acuity (BCVA) was worse than finger counting in 18 eyes, worse than 0.1 in 15 eyes, 0.1-0.3 in 16 eyes and better than or equal to 0.3 in 1 eye. Post-operative tamponade was delivered for patients with iatrogenic retinal breaks, including 5 eyes with long-acting gas and 7 eyes with silicone oil. The mean follow-up time was 9.7 months. The visual outcome, rate of retinal reattachment and complications were analyzed. ResultsThe visual acuity improved in 34 eyes (68.0%), unchanged in 12 eyes (24.0%) and decreased in 4 eyes (8.0%). The difference of visual acuity before and after surgery was statistically significant (t=7.087, P<0.01).The total rate of retinal reattachment was 96%, and 84% of eyes achieved anatomic reattachment after single surgery. The rate of retinal reattachment was 89.5% (34/38) for these eyes without iatrogenic retinal breaks, 4/38 eyes without iatrogenic retinal breaks still had retinal detachment in 3 months after surgery and received tamponade of long-acting gas or silicone oil. The rate of retinal reattachment was 66.7% (8/12) for these eyes with iatrogenic retinal breaks and received post-operative tamponade. There were 17 eyes experienced postoperative vitreous hemorrhage, which were treated with anti-vascular endothelial growth factor (VEGF) antibodies or vitreous cavity lavage. There were 9 eyes with transient ocular hypertension, and 4 eyes with neovascular glaucoma (NVG). Among 4 eyes with NVG, 2 of which were controlled through anti-VEGF treatment or laser treatment, and 2 eyes of 2 patients refused to have further treatment. ConclusionSGV is safe and effective treatment for PDR combined with TRD, and intraocular tamponade is not necessary in the absence of iatrogenic retinal break.
ObjectiveTo investigate the risk factors for neovascular glaucoma (NVG) after vitrectomy in proliferative diabetic retinopathy (PDR) patients. MethodsThree hundred and one patients (301 eyes) with PDR who underwent vitrectomy between January 2008 and December 2013 in our hospital were retrospectively evaluated. Risk factors for NVG after vitrectomy were identified by multivariate Logistic regression analysis. ResultsTwelve of 301 patients (4.0%) developed postoperative NVG in 2 to 18 months after vitrectomy. The incidence of postoperative NVG peaked in 2 to 6 months after vitrectomy (7 eyes, 58.3%). Logistic regression analysis showed that postoperative retinal detachment was a significant risk factor for postoperative NVG in eyes with PDR (P < 0.001). Eyes with postoperative retinal detachment were more likely to develop NVG after vitrectomy than those without postoperative retinal detachment (OR=17.826). Gender, age, duration of diabetes, preoperative serum creatinine levels, glycated hemoglobin levels, preoperative intraocular pressure, preoperative lens status, combined phacoemulsification surgery and tamponade were not associated with postoperative NVG (P > 0.05). ConclusionPostoperative retinal detachment is a major risk factor for NVG after vitrectomy in PDR.
ObjectiveTo observe the effect of microincision vitrectomy assisted with intravitreaI injection of ranibizumab (IVR) in proliferative diabetic retinopathy (PDR) treatment. MethodsThis is a prospective, randomized, and comparative case series study. A total of 92 patients (92 eyes) with PDR were recruited to have microincision vitrectomy with (combined group) or without (PPV group) IVR. There are 48 eyes in the combined group and 44 eyes in the PPV group. The average operation time, iatrogenic breaks, the use of tamponade and electric coagulation, postoperative bleeding and best corrected visual acuity were comparatively analyzed among the two groups.The mean follow-up was (14.3±5.2) months. ResultsThe average operation time was (59.4±18.5) min in the combined group and (74.6±16.2) min in the PPV group. The rate of silicone oil tamponade (χ2=4.619), inert gas tamponade (χ2=4.290), electric coagulation (χ2=8.039) and iatrogenic breaks (χ2=4.330) in the combined group were significantly decreased compared with PPV group(P<0.05). The mean logMAR BCVA was 0.83±0.44 in the combined group and 1.37±0.53 in the PPV group, which significantly improved from preoperatively (t=3.257, 3.012; P<0.05). The rate of BCVA improvement in the combined group was significantly higher than that in the PPV group (t=2.972, P<0.05). The incidence of the recurrent vitreous hemorrhage was 2.1% in the combined group and 9.1% in the PPV group (χ2=6.741, P<0.05). There was no severe complication associated with surgery, such as choroidal detachment, retinal detachment and endophthal-mitis. ConclusionIVR before the microincision vitrectomy can shorten the operation time, reduce the use of electric coagulation and intraocular tamponade, and improve visual acuity for PDR patients.
Objective To observe and analyze the causes and prognosis of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR). Methods A total of 160 PDR patients (171 eyes) were enrolled in this retrospective study. There were 85 males and 75 females. The patients aged from 33 to 73 years, with the mean age of (56.40±8.97) years. All the patients were performed 25G pars plana vitrectomy by the same doctor. Fibrovascular membrane peeling and panretinal photocoagulation were performed during the operation. Combined phacoemulsification was performed in one hundred and five patients. Vitreous tamponade was used at the end of surgery, including silicone oil (43 eyes), C3F8 (63 eyes), air or fluid (65 eyes). The follow-up ranged from 6 to 22 months, with the mean follow-up of (9.34±6.97) months. The features of PVH were observed. The difference of age, HbA1c, creatinine level, the severity of the fundus lesions, whether received treatment of anti-vascular endothelial growth factor (VEGF), whether received combined cataract phacoemulsification were analyzed to find out the cause and prognosis of PVH. Results The corrected vision of all the patients after the primary PPV at the latest follow up was finger counting/1 meter. PVH occurred in 15 eyes of 15 patients, the incidence was 8.77%. The PVH occurred 2 weeks to 6 months after surgery. There were significant difference in age (t=2.551), proportion with tractional retinal detachment (χ2=7.431), progressive fibrovascular proliferation (χ2=4.987) and using anti-VEGF (χ2=9.742) between the patients with and without PVH (P＜0.05). There was no significant difference in HbA1c (t=0.501), creatinine level (t=1.529), and the proportion of cataract phacoemulsification (χ2=0.452) between the patients with and without PVH (P＞0.05). During follow-up, neovascularization of iris (NVI) occurred in 1 eye and neovascular glaucoma (NVG) occurred in 4 eyes. Seven eyes underwent reoperation, 7 eyes were spontaneous recovered, 1 eye with NVG give up treatment. Fibrovascular membrane was the major cause of recurrent hemorrhage. At the end of follow-up, hemorrhage was absorbed in all the 14 eyes which were treated, 12 eyes had same visual acuity compared to that before postoperative hemorrhage, 2 eyes with NVG had decreased vision. There was significant difference in the corrected vision between the patients with and without NVI or NVG (P=0.022). Conclusions PVH after PPV for PDR is closely related to the severity of diabetic retinopathy, fibrovascular membrane is the major cause of recurrent hemorrhage. NVG is an important factor related to vision acuity prognosis.
Objective To observe the clinical features and outcomes of vitrectomy for diabetic retinopathy (DR) with central retinal vein occlusion (CRVO) in type 2 diabetes mellitus (T2DM). Methods A total of 192 patients (241 eyes) with proliferative DR (PDR) who underwent vitrectomy were enrolled in this study. All the patients were diagnosed as vitreous hemorrhage (VH) because of suddenly decreased vision. There were 93 eyes with tractional retinal detachment (TRD) and six eyes with neovascularization of iris (NVI). The patients were divided into PDR with CRVO group (group A, 41 eyes) and PDR group (group B, 200 eyes) according to the results of fundus examination. All patients received vitrectomy with silicone oil and C3F8 gas tamponade. There were 138 eyes with silicone oil tamponade which including 30 eyes in group A and 108 eyes in group B. The difference of number in silicone oil-filled eyes in two groups was statistically significant (chi;2=5.110,P＜0.05). There were 38 eyes with C3F8 gas tamponade which including six eyes in group A and 32 eyes in group B. There was no difference in C3F8 gas-filled eyes numbers in two groups (chi;2=0.048, P＞0.05). The follow-up ranged from one to 60 months, with the mean of (28.69plusmn;17.28) months. The corrected vision, retinal reattachment, persisting macular edema (ME), neovascular glaucoma (NVG) and repeated VH after surgery were comparatively analyzed. Results Of 241 eyes, there were 41 eyes (17.0%) with CRVO. Before surgery, the differences of corrected vision (Z=-0.138), intraocular pressure (t=0.966), whether there was TRD or not (chi;2=0.412), whether underwent panretinal photocoagulation or not (chi;2=1.416) were not statistically significant (P＞0.05), but the difference of whether NVI were present or not was statistically significant (chi;2=31.724,P＜0.05) between two groups. After surgery, the corrected vision improved in both two groups (Z=2.319, 4.589; P＜0.05). There was no difference of corrected vision after surgery between two groups (Z=0.782,P＞0.05). Postoperative complications occurred in 94 eyes, including 26 eyes in group A and 68 eyes in group B. The differences of incidence of reoperation (chi;2=0.498), retinal reattachment (chi;2=0.818), persisting ME (chi;2=2.722) between two groups after surgery were not statistically significant (P＞0.05). The incidence of repeated VH (chi;2=5.737) and NVG (chi;2=6.604) in group A were higher than those in group B (P＜0.05). Conclusions CRVO is commonly found to coexist with DR in T2DM patients with VH. Combined with CRVO patients are more likely to suffer NVI. Vitrectomy can improve the visual function in PDR with CRVO patients.
Objective To observe the short-term intraocular pressure after 25G+ pars plana vitrectomy (PPV) and analyze the possible influencing factors in rhegmatogenous retinal detachment (RRD) and proliferative diabetic retinopathy (PDR) eyes. Methods This is a retrospective case-control study. A total of 160 patients (163 eyes) of RRD and PDR who underwent 25G+ PPV were enrolled in this study. There were 88 males (89 eyes) and 72 females (74 eyes), with the mean age of (50.37±13.24) years. There were 90 patients (92 eyes) with RRD (the RRD group) and 70 patients (74 eyes) with PDR (the PDR group). Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were performed on all the patients. The BCVA was ranged from hand motion to 0.6. The average IOP was (12.61±4.91) mmHg (1 mmHg=0.133 kPa). There were significant differences in crystalline state (χ2=9.285, P=0.009), IOP (χ2=58.45, P=0.000), history of PPV (χ2=4.915, P=0.027) and hypertension (χ2=24.018, P=0.000), but no significant difference in sex (χ2=0.314, P=0.635) and age (χ2=5.682, P=0.056) between the two groups. A non-contact tonometer has been used to measure IOP on postoperative day 1 and 3. The postoperative IOP distribution has been divided into five groups: severe ocular hypotension (≤5 mmHg), mild ocular hypotension (6 - 9 mmHg), normal (10 - 21 mmHg), mild ocular hypertension (22 - 29 mmHg), severe ocular hypertension (≥30 mmHg). Logistic regression analysis has been used to analyze the risk and protective factors. Results On the first day after surgery, there were 21 eyes (12.9%) in mild ocular hypotension, 96 eyes (58.9%) in normal, 22 eyes (13.4%) in mild ocular hypertension and 24 eyes (14.7%) in severe ocular hypertension. On the first day after surgery, there were 18 eyes (11.0%) in mild ocular hypotension, 117 eyes (71.7%) in normal, 23 eyes (14.1%) in mild ocular hypertension and 5 eyes (3.1%) in severe ocular hypertension. There was no significant difference of IOP distribution between the two groups (Z=?1.235, ?1.642; P=0.217, 0.101). The results of logistic regression analysis showed that silicone tamponade was a risk factor for ocular hypertension in PDR eyes on the first day after surgery [odds ratio (OR)=15.400, 95% confidence interval (CI) 3.670 - 64.590; P＜0.001], while intraocular lens was the risk factor for ocular hypotension in PDR eyes on third day after surgery (OR=19.000, 95%CI 1.450 - 248.2; P=0.025). As for RRD eyes, the ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=3.755, 95%CI 1.088 - 12.955; P=0.036). For all eyes, silicone tamponade (OR=0.236, 95%CI 0.070 - 0.797), air tamponade (OR=0.214, 95%CI 0.050 - 0.911) and inert gas tamponade (OR=0.092, 95%CI 0.010 - 0.877) were protective factors for ocular hypotension on the first day after surgery (P=0.020, 0.037, 0.038); silicone tamponade was protective factor for ocular hypotension on the third day after surgery (OR=0.249, 95% CI 0.066 - 0.94, P=0.040); while aphakic eyes was the risk factor for ocular hypotension on third day after surgery (OR=7.765, 95% CI 1.377 - 43.794, P=0.020). The ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=4.034, 95% CI 1.475 - 11.033, P=0.007). Conclusions The abnormal IOP is common after 25G+ PPV with a rate from 28.3% to 31.1%. Silicone tamponade, air tamponade and inert gases tamponade are protective factors for postoperative ocular hypotension, aphakic eye is risk factor for postoperative ocular hypotension. Ocular hypotension before surgery and silicone oil tamponade are risk factors for postoperative ocular hypertension.