Šín Martin, Chrapek Oldřich, Karhanová Marta, Šínová Irena, Špačková Kareřina, Langová Kateřina, Řehák Jiří
Department of Ophthalmology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
TANA Ophthalmology Clinic, Olomouc, Czech Republic.
Acta Ophthalmol. 2016 Feb;94(1):41-7. doi: 10.1111/aos.12828. Epub 2015 Aug 27.
To determine the effect of pars plana vitrectomy (PPV) on oxygen saturation in retinal vessels in patients with diabetes and non-diabetes after a 1-year follow-up.
This was a prospective consecutive interventional case series in 82 eyes in 82 patients. The sample consisted of 25 patients with non-proliferative diabetic retinopathy with macular oedema based on vitreoretinal traction or epiretinal membrane (ERM) and 57 non-diabetic patients with macular hole and ERM. Automatic retinal oximetry (Oxymap Inc.) was used on all patients 24 hr prior to PPV, and it was also used 7 and 52 weeks after PPV (classic 20G or sutureless 23G). We analysed the data according to subgroup diagnosis and lens status.
Arterial saturation increased significantly from 96.4 ± 2.9% at baseline to 96.6 ± 3.4% at week 7 and 97.3 ± 3.4% at week 52 (p < 0.0001; Friedman test). Vein saturation also increased significantly from 63.5 ± 7.9% at baseline to 66.1 ± 7.7% and 67.0 ± 7.2% at weeks 7 and 52 (p < 0.0001; Friedman test). The value of the arteriovenous (A-V) difference decreased significantly after vitrectomy from 32.8 ± 7.5% at baseline to 30.5 ± 7.5% and 30.3 ± 7.0% at weeks 7 and 52 (p < 0.0001; Friedman test). The subgroup analysis revealed that in patients with diabetes, there were no statistically significant changes in oxygen saturation in blood vessels or in the A-V difference after PPV. After vitrectomy, retinal vessel diameter reduced by about 3.5% in both groups of patients. Further, the analysis revealed that opacification of the lens leads to a decrease in oxygen saturation in contrast to a clear lens and pseudophakic IOLs.
Oxygen saturation is higher in the retinal veins and arteries after PPV in patients with non-diabetes, and this lasts for at least 52 weeks. In contrast, in patients with diabetes, there is no increase in oxygen saturation in the retinal vessels after vitrectomy. After vitrectomy, retinal vessel diameter reduced in both groups of patients. Further, the nuclear cataract progression has substantial effect on oximetry results. Patients with nuclear cataract exhibited an increase in saturation in both arteries and veins, but the A-V difference remained the same.
确定玻璃体切割术（PPV）对糖尿病患者和非糖尿病患者视网膜血管氧饱和度的影响，随访期为1年。
这是一项前瞻性连续介入病例系列研究，纳入82例患者的82只眼。样本包括25例基于玻璃体视网膜牵拉或视网膜前膜（ERM）的非增殖性糖尿病视网膜病变伴黄斑水肿患者，以及57例黄斑裂孔和ERM的非糖尿病患者。所有患者在PPV术前24小时使用自动视网膜血氧测定仪（Oxymap公司），并在PPV术后7周和52周（经典20G或无缝合23G）使用。我们根据亚组诊断和晶状体状态分析数据。
动脉血氧饱和度从基线时的96.4±2.9%显著增加到第7周时的96.6±3.4%和第52周时的97.3±3.4%（p<0.0001；Friedman检验）。静脉血氧饱和度也从基线时的63.5±7.9%显著增加到第7周和第52周时的66.1±7.7%和67.0±7.2%（p<0.0001；Friedman检验）。玻璃体切割术后动静脉（A-V）差值从基线时的32.8±7.5%显著降低到第7周和第52周时的30.5±7.5%和30.3±7.0%（p<0.0001；Friedman检验）。亚组分析显示，糖尿病患者PPV术后血管血氧饱和度及A-V差值无统计学显著变化。玻璃体切割术后，两组患者视网膜血管直径均减少约3.5%。此外，分析显示，与透明晶状体和人工晶状体相比，晶状体混浊导致血氧饱和度降低。
非糖尿病患者PPV术后视网膜动静脉血氧饱和度升高，且至少持续52周。相比之下，糖尿病患者玻璃体切割术后视网膜血管血氧饱和度无增加。玻璃体切割术后，两组患者视网膜血管直径均减小。此外，核性白内障进展对血氧测定结果有显著影响。核性白内障患者动静脉血氧饱和度均升高，但A-V差值不变。
