Ono Ryuichiro, Kakehashi Akihiro, Yamagami Hiroko, Sugi Norito, Kinoshita Nozomi, Saito Takako, Tamemoto Hiroyuki, Kuroki Masatoshi, Lshikawa San-E, Kawakami Masanobu
Department of Ophthalmology, Jichi Medical University, Omiya Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
Int Ophthalmol. 2005 Feb-Apr;26(1-2):15-9. doi: 10.1007/s10792-005-5389-2. Epub 2006 Jun 15.
To study the relation between posterior vitreous detachment (PVD) and progression of diabetic retinopathy (DR), based on our observation that proliferative DR is rare in patients with complete PVD.
The medical records of 403 patients with diabetes were reviewed for the relation between progressive DR and the status of PVD and HbA(1c) over 3 years. PVD was classified into none, complete PVD with collapse, complete PVD without collapse, partial PVD with a thickened posterior vitreous cortex, and partial PVD without a thickened posterior vitreous cortex. DR was classified into none, simple, preproliferative, or proliferative. When it became more extensive or when laser treatment or vitreous surgery was performed, the DR was considered progressive.
Progression of DR over 3 years occurred in 128/292 (43.8%) eyes with no PVD, 0/14 (0%) eyes with complete PVD with collapse, 2/8 (25%) eyes with complete PVD without collapse, 15/15 (100%) eyes with partial PVD with a thickened posterior vitreous cortex, and 19/74 (25.7%) eyes with partial PVD without a thickened posterior vitreous cortex. Progression of DR occurred significantly more frequently in eyes with partial PVD with a thickened posterior vitreous cortex compared to eyes with complete PVD with collapse (p<0.0001). HbA(1c), did not differ significantly between these two groups (6.9 +/- 0.9% and 7.5 +/- 0.9%, respectively; p = 0.14), although HbA(1c) was significantly higher (p = 0.04) in patients with progressive DR (78 +/- 1.8%) than in patients without progressive DR (7.5 +/- 1.5%).
Complete PVD is a strong negative risk factor for DR. The PVD status in patients with diabetes should be evaluated.
基于我们观察到完全性玻璃体后脱离（PVD）患者中增殖性糖尿病视网膜病变（DR）罕见这一现象，研究玻璃体后脱离与糖尿病视网膜病变进展之间的关系。
回顾403例糖尿病患者的病历，分析3年期间进展性DR与PVD状态及糖化血红蛋白（HbA₁c）之间的关系。PVD分为无、伴有塌陷的完全性PVD、不伴有塌陷的完全性PVD、伴有增厚的玻璃体后皮质的部分性PVD以及不伴有增厚的玻璃体后皮质的部分性PVD。DR分为无、单纯性、增殖前期或增殖性。当DR范围扩大或进行激光治疗或玻璃体手术时，则认为DR有进展。
在无PVD的292只眼中，128只（43.8%）在3年内出现DR进展；伴有塌陷的完全性PVD的14只眼中，0只（0%）出现DR进展；不伴有塌陷的完全性PVD的8只眼中，2只（25%）出现DR进展；伴有增厚的玻璃体后皮质的部分性PVD的15只眼中，15只（100%）出现DR进展；不伴有增厚的玻璃体后皮质的部分性PVD的74只眼中，19只（25.7%）出现DR进展。与伴有塌陷的完全性PVD的眼相比，伴有增厚的玻璃体后皮质的部分性PVD的眼中DR进展明显更频繁（p<0.0001）。这两组之间的HbA₁c无显著差异（分别为6.9±0.9%和7.5±0.9%；p = 0.14），尽管进展性DR患者的HbA₁c显著高于无进展性DR患者（分别为7.8±1.8%和7.5±1.5%，p = 0.04）。
完全性PVD是DR的一个强有力的负性危险因素。应对糖尿病患者的PVD状态进行评估。
