Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Eur J Ophthalmol. 2021 Nov;31(6):3057-3067. doi: 10.1177/1120672120980686. Epub 2020 Dec 18.
The incidence and risk factors of neovascular glaucoma (NVG) secondary proliferative diabetic retinopathy (PDR) after pars plana vitrectomy (PPV) are unclear and reports in the published literature are inconsistent. Therefore, a systematic review and meta-analysis were conducted to clarify the risk factors associated with neovascular glaucoma.
PubMed, Embase, and The Cochrane Library were systematically searched without language limitations for studies related to NVG after PPV in PDR patients. We used R software to fit the correlation between incidence and the date of publication for studies and performed a Spearman analysis. For binary and continuous variables, the odds ratios (ORs) with 95% confidence intervals (CIs) were pooled, respectively, using Review Manager 5.3 (The Cochrane Collaboration).
Twenty-six studies with 5161 patients were included in our meta-analysis. The overall pooled incidence of NVG after PPV in PDR patients was 6% (95% CI, 0.05-0.07, -value < 0.00001). Pooled estimates indicated a positive correlation for NVG after PPV in PDR patients with higher baseline IOP (OR, 1.26; 95%CI,0.56-1.95, -value = 0.0004), preoperative iris neovascularization (INV) (OR, 5.66; 95% CI, 2.10-15.23, -value = 0.0006), preoperative or intraoperative combined cataract surgery (OR, 2.00; 95% CI, 1.15-3.46, -value = 0.01), postoperative vitreous hemorrhage (VH) (OR, 3.53; 95% CI, 1.63-7.66, -value = 0.001), and a negative correlation with age (OR, -2.90; 95%CI, -5.00 to -0.81, -value < 0.007).
Our systematic review and meta-analysis indicated that the main risk factors for NVG after PPV in PDR patients included higher baseline IOP, preoperative INV, preoperative or intraoperative combined cataract surgery, postoperative VH, and was negatively correlated with age.
关于接受玻璃体切除术（PPV）治疗后的增生性糖尿病视网膜病变（PDR）患者发生新生血管性青光眼（NVG）的发生率和风险因素尚不清楚，且文献报道也不一致。因此，我们进行了一项系统评价和荟萃分析，以明确与 NVG 相关的风险因素。
我们系统地检索了 PubMed、Embase 和 The Cochrane Library，检索语言不受限制，以获取与 PDR 患者接受 PPV 治疗后发生 NVG 相关的研究。我们使用 R 软件拟合研究中发生率与发表日期之间的相关性，并进行 Spearman 分析。对于二分类变量和连续变量，分别使用 Review Manager 5.3（Cochrane 协作网）汇总优势比（OR）及其 95%置信区间（CI）。
本荟萃分析共纳入 26 项研究，共计 5161 例患者。接受 PPV 治疗后的 PDR 患者发生 NVG 的总体汇总发生率为 6%（95%CI，0.05-0.07，P<0.00001）。汇总估计结果表明，基线眼压较高（OR，1.26；95%CI，0.56-1.95，P=0.0004）、术前虹膜新生血管形成（INV）（OR，5.66；95%CI，2.10-15.23，P=0.0006）、术前或术中联合白内障手术（OR，2.00；95%CI，1.15-3.46，P=0.01）、术后玻璃体积血（VH）（OR，3.53；95%CI，1.63-7.66，P=0.001）与接受 PPV 治疗后的 PDR 患者发生 NVG 呈正相关，而与年龄呈负相关（OR，-2.90；95%CI，-5.00 至-0.81，P<0.007）。
我们的系统评价和荟萃分析表明，接受 PPV 治疗后的 PDR 患者发生 NVG 的主要风险因素包括基线眼压较高、术前 INV、术前或术中联合白内障手术、术后 VH，且与年龄呈负相关。
