Retina Service, Wills Eye Institute, Philadelphia, Pennsylvania 19107, USA.
Am J Ophthalmol. 2013 Apr;155(4):757-63, 763.e1-2. doi: 10.1016/j.ajo.2012.11.004. Epub 2013 Jan 11.
To report the frequency of postoperative vitreous hemorrhage (VH) in eyes that underwent primary 23-gauge pars plana vitrectomy (PPV) for nonclearing VH resulting from proliferative diabetic retinopathy, as well as associated risk factors.
Retrospective, consecutive, interventional case series.
Institutional (Retina Service of Wills Eye Institute).
One hundred seventy-three eyes of 157 patients.
Twenty-three-gauge PPV for nonclearing diabetic VH.
Percentage of eyes in which postoperative VH developed, categorized as early, delayed, or severe persistent, as well as percentage requiring reoperation.
During a mean follow-up of 32 weeks, 56 (32%) of 173 eyes demonstrated postoperative VH, categorized as early (8 eyes; 5%), delayed (13 eyes; 8%), or severe persistent (35 eyes; 20%). Twenty-two (13%) of 173 eyes required reoperation: 4 (50%) of 8 in the early group, 8 (62%) of 13 in the delayed group, and 10 (29%) of 35 in the severe persistent group. Mean preoperative logarithm of the minimum angle of resolution visual acuity was 1.5 (Snellen equivalent, approximately 20/600); mean postoperative VA was 0.65 (Snellen equivalent, approximately 20/90), a gain of 0.85 (P < .0001). Thirty-four (27%) of 127 eyes with complete scatter photocoagulation before undergoing PPV compared with 22 (48%) of 46 eyes with incomplete scatter photocoagulation before undergoing PPV demonstrated postoperative VH (P = .002). Other factors associated with postoperative VH included younger age (P = .022) and phakia (P = .036).
Postoperative VH was not uncommon after initial 23-gauge PPV for diabetic VH and was associated with incomplete scatter photocoagulation, younger age, and phakia before PPV. However, only a minority of patients required reoperation.
报告因增生性糖尿病视网膜病变导致的非澄清性玻璃体积血（VH）而接受 23G 经睫状体平坦部玻璃体切除术（PPV）的初次手术后 VH 的发生率，以及相关的危险因素。
回顾性、连续、干预性病例系列。
机构（Wills 眼科研究所视网膜科）。
157 例患者的 173 只眼。
23G 经睫状体平坦部 PPV 治疗非澄清性糖尿病 VH。
术后 VH 发展的眼百分比，分为早期、延迟或严重持续性，以及需要再次手术的百分比。
在平均 32 周的随访中，173 只眼中的 56 只（32%）出现术后 VH，分为早期（8 只眼；5%）、延迟（13 只眼；8%）或严重持续性（35 只眼；20%）。173 只眼中的 22 只（13%）需要再次手术：早期组 4 只（50%），延迟组 8 只（62%），严重持续性组 10 只（29%）。术前最小分辨角对数视力的平均 LogMAR 值为 1.5（Snellen 等价物，约为 20/600）；术后平均 VA 为 0.65（Snellen 等价物，约为 20/90），增益为 0.85（P<0.0001）。与术前不完全散射光凝的 46 只眼相比，术前完全散射光凝的 127 只眼中有 34 只（27%）出现术后 VH（P=0.002）。与术后 VH 相关的其他因素包括年龄较小（P=0.022）和白内障（P=0.036）。
初次 23G 经睫状体平坦部 PPV 治疗糖尿病 VH 后，术后 VH 并不少见，且与术前不完全散射光凝、年龄较小和白内障有关。然而，只有少数患者需要再次手术。
