Department of Ophthalmology, Glostrup University Hospital, Copenhagen, Denmark.
Acta Ophthalmol. 2014 Sep;92(6):571-6. doi: 10.1111/aos.12325. Epub 2013 Dec 23.
To report long-term results, prognostic factors and cataract surgery after diabetic vitrectomy.
Retrospective review of patient files from a large diabetes centre between 1996 and 2010. Surgical history was obtained from the Danish National Patient Register. Follow-up intervals were 3 months and 1, 3, 5 and 10 years after surgery.
In total, 167 patients had diabetic vitrectomy indicated for non-clearing vitreous haemorrhage (47%) and tractional retinal detachment (53%). The proportion of patients with visual acuity ≥0.3 increased from 29% before surgery to 60% after 3 months (p < 0.001, chi-square test). Median visual acuity increased from 0.06 before surgery to 0.3 after 3 months (p < 0.001, paired signed-rank test) and 0.4 after 1 year (p = 0.009) before stabilizing. No significant long-term prognostic factors were identified for non-clearing vitreous haemorrhage patients. For tractional retinal detachment patients, use of silicone oil was associated with low vision (visual acuity<0.3) after 3 months and 1, 3 and 5 years (all odds ratios >4 and p-values ≤ 0.03, logistic regression). Of the 134 patients who were phakic after surgery, 43% and 29% were phakic after 5 and 10 years, respectively. Use of silicone oil increased the risk of cataract surgery (p = 0.009, log-rank test).
Most diabetic vitrectomy patients stand to gain visual acuity ≥0.3 after surgery and a stable long-term visual acuity after 1 year. The only consistent long-term predictor of low vision after surgery is use of silicone oil for endotamponade. About 2/3 of phakic patients will subsequently have cataract surgery the first 10 years after diabetic vitrectomy.
报告糖尿病玻璃体切除术后的长期结果、预后因素和白内障手术情况。
回顾性分析 1996 年至 2010 年间一家大型糖尿病中心的患者病历。手术史从丹麦国家患者登记处获得。术后随访间隔为 3 个月和 1、3、5、10 年。
共有 167 例患者因非清除性玻璃体积血（47%）和牵拉性视网膜脱离（53%）接受糖尿病玻璃体切除术。手术后视力≥0.3 的患者比例从术前的 29%增加到 3 个月时的 60%（p<0.001，卡方检验）。中位视力从术前的 0.06 增加到 3 个月时的 0.3（p<0.001，配对符号秩检验），1 年后增加到 0.4（p=0.009），然后稳定。未发现非清除性玻璃体积血患者的长期预后因素。对于牵拉性视网膜脱离患者，术后 3 个月和 1、3、5 年时使用硅油与低视力（视力<0.3）相关（所有比值比>4，p 值≤0.03，logistic 回归）。术后 134 例未行白内障手术的患者中，5 年和 10 年后有 43%和 29%仍为未行白内障手术。使用硅油增加了白内障手术的风险（p=0.009，对数秩检验）。
大多数糖尿病玻璃体切除术患者术后视力≥0.3，1 年后视力稳定。术后低视力的唯一一致长期预测因素是硅油用于眼内填塞。约 2/3 的未行白内障手术的患者在糖尿病玻璃体切除术后的头 10 年内将随后行白内障手术。
