Laser and Retinal Research Unit, Department of Opthalmology, King's College Hospital, London, UK.
Eye (Lond). 2012 Apr;26(4):510-6. doi: 10.1038/eye.2011.321. Epub 2012 Jan 6.
End-stage diabetic eye disease is an important cause of severe visual impairment in the working-age group. With the increasing availability of refined surgical techniques as well as the early diagnosis of disease because of screening, one would predict that the prevalence of this condition is decreasing and the visual outcome is improving.
To study the prevalence and visual outcome following vitrectomy for complications of diabetic retinopathy.
This study identified the patients who underwent vitrectomy from January 2007 to December 2009 because of diabetes-related complications in South East London. Data collected included baseline demographics, best-corrected visual acuity, indication for the vitrectomy, complication, outcome, and duration of follow-up.
The prevalence of people requiring vitrectomy who are registered in the diabetes register of this region was 2 per 1000 people with diabetes. Vitrectomy was required in 185 eyes of 158 patients during this period. These included 83 Caucasians, 51 Afro-Caribbeans, 17 South Asians, and 7 from other ethnic groups. There were 58 patients with type I diabetes and 100 with type II, with a mean duration of diabetes of 23 and 16.5 years, respectively. The reason for vitrectomy included tractional retinal detachment (TRD) in 109 eyes, non-clearing vitreous haemorrhage (NCVH) in 68 eyes, and other causes in 8 eyes. In all, 50% of the eyes with TRD and NCVH, and 87% of the eyes with NCVH improved by at least three ETDRS lines at 12 months. Poor predictors of visual success included longer duration of diabetes (OR: 0.69), use of insulin (OR: 0.04), presence of ischaemic heart disease (OR: 0.04), delay in surgery (OR: 0.59), and the failure to attend clinic appointments (OR: 0.58). Preoperative use of intravitreal bevacizumab in eyes with TRD undergoing vitrectomy showed a marginal beneficial effect on co-existent maculopathy (P=0.08) and required less laser intervention post procedure, but did not affect the number of episodes of late-onset vitreous haemorrhage post vitrectomy (P=0.81).
Visual outcome has improved significantly in eyes with complications due to diabetic retinopathy compared with the previously reported Diabetic Vitrectomy Study.
糖尿病性终末期眼病是工作年龄段人群严重视力损害的一个重要原因。随着精细手术技术的不断普及以及因筛查而使疾病的早期诊断成为可能，人们预计这种疾病的患病率正在下降，而且视力预后正在改善。
研究因糖尿病性视网膜病变并发症而行玻璃体切除术的患病率和视力预后。
本研究在伦敦东南部，对 2007 年 1 月至 2009 年 12 月期间因糖尿病相关并发症而接受玻璃体切除术的患者进行了病例回顾。收集的数据包括基线人口统计学特征、最佳矫正视力、玻璃体切除术的适应证、并发症、结果以及随访时间。
在该地区糖尿病登记处登记的需要行玻璃体切除术的患者患病率为每 1000 人中有 2 人。在此期间，158 名患者的 185 只眼需要行玻璃体切除术。其中包括 83 名白种人、51 名非裔加勒比人、17 名南亚人和 7 名其他种族的人。58 名患者为 1 型糖尿病，100 名患者为 2 型糖尿病，糖尿病的平均病程分别为 23 年和 16.5 年。玻璃体切除术的原因包括牵拉性视网膜脱离（TRD）109 只眼、未吸收性玻璃体积血（NCVH）68 只眼和其他原因 8 只眼。总的来说，TRD 和 NCVH 中 50%的眼和 NCVH 中 87%的眼在 12 个月时视力至少提高了 3 个 ETDRS 线。视力成功的不良预测因素包括糖尿病病程较长（OR：0.69）、使用胰岛素（OR：0.04）、存在缺血性心脏病（OR：0.04）、手术延迟（OR：0.59）和未能按时就诊（OR：0.58）。TRD 患者在接受玻璃体切除术前使用玻璃体腔内贝伐单抗治疗对视功能有一定的有益影响（P=0.08），并且术后需要较少的激光干预，但不会影响玻璃体切除术后晚期玻璃体积血的发作次数（P=0.81）。
与之前报道的糖尿病玻璃体切除术研究相比，糖尿病性视网膜病变并发症所致眼的视力预后有显著改善。
