Ramezani Alireza, Ahmadieh Hamid, Rozegar Amin, Soheilian Masoud, Entezari Morteza, Moradian Siamak, Dehghan Mohammad H, Nikkhah Homayoun, Yaseri Mehdi
Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Korean J Ophthalmol. 2017 Jun;31(3):217-229. doi: 10.3341/kjo.2016.0018. Epub 2017 May 12.
To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR).
This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate.
At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200.
Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.
评估增殖性糖尿病视网膜病变（PDR）患者玻璃体切除联合硅油（SO）注入术后的视力及解剖学结果，并确定影响手术效果的相关因素。
本回顾性研究纳入了236例接受玻璃体切除联合SO注入且随访时间超过3个月的PDR患者。主要观察指标为最终最佳矫正视力（BCVA）和视网膜复位率。
末次随访时（平均88±58周），分别有86.9%、10.6%和2.5%的患者视网膜完全复位、部分复位及未复位。共有155只眼已取出SO，81只眼仍保留SO。初始平均BCVA为1.9±0.7最小分辨角对数（logMAR），最终显著改善至1.7±0.8 logMAR（p = 0.001）。初始黄斑脱离（校正比值比[AOR]，0.25）、医源性裂孔形成（AOR，0.25）以及使用重质SO（AOR，0.13）与最终视网膜复位风险较低独立相关，而取出SO与较高的发生率相关（AOR，7.55）。较好的基线BCVA与最终BCVA≥20/200的较高风险相关。
尽管玻璃体切除联合SO治疗晚期PDR的解剖学数据显示出令人鼓舞的结果，但患者的功能预后并不理想。基线视力较好的眼预后更佳，而初始黄斑脱离、术中医源性裂孔或使用重质SO的眼预后较差。在某些特定情况下，延长SO使用时间并未使预后恶化。
