Zheng C Z, Ren X J, Ke Y F, Wen D J, Li X R
Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin 300384, China.
Zhonghua Yan Ke Za Zhi. 2021 Jun 11;57(6):440-446. doi: 10.3760/cma.j.cn112142-20200812-00538.
To report the efficacy and safety of minimally invasive vitrectomy for the treatment of severe proliferative diabetic retinopathy (PDR) and the effect of preoperative retinal photocoagulation on prognosis. Case-series study and cohort study. This study included 48 severe PDR patients (53 eyes). There are 28 males and 20 females. The average age was 53.5 (range, 40.0 to 59.0) years old. Patients were divided into two groups according to whether preoperative retinal photocoagulation was performed. Under the guidance of the concept of minimally invasive vitrectomy, all patients received intravitreal injection of conbercept 3 days before standard pars plana vitrectomy with a 27G+ vitrectomy system. To relieve traction, the proliferative fibrovascular membrane was divided into islands as small as possible. It was not necessary to pursue a complete removal of the proliferative membrane. The 27G+ vitrector was flexibly applied as a multifunctional tool for membrane removal by reducing frequencies at which the device entered and left the eye. Intraocular retinal photocoagulation was performed in the main area. The primary outcome measures were best corrected visual acuity (BCVA) and retinal reattachment rate, and the secondary outcome measures were intraoperative and postoperative complications. Statistical analysis was performed using test, rank sum test and χ² test. All patients tolerated intravitreal conbercept, with no serious intraoperative or postoperative adverse events. Postoperative BCVA values were improved significantly compared with preoperative values (χ²=125.11, <0.01). The mean logMAR BCVA improved from 1.90 (1.30, 2.30) preoperatively to 1.00 (0.70, 1.90) at 1 week postoperatively, 0.8 (0.5, 1.3) at 1 month postoperatively, 0.7 (0.40, 1.20) at 3 months postoperatively, and 0.70 (0.40, 1.20) at 6 months postoperatively. The visual function increased progressively with time. Postoperatively, the primary and final reattachment rates were 92.5% (50/53) and 96.2% (51/53), respectively. Abnormal intraocular pressure lasted for more than one week occurred in 2 eyes; Vitreous hemorrhage recurred in 5 eyes; Retinal detachment occurred in 4 eyes (7.5%); No postoperative endophthalmitis, choroidal detachment or incision related retinal hole occurred. The intraoperative and postoperative parameters in the preoperative retinal photocoagulation group were better than the preoperative non-photocoagulation group, but the difference was not significant (>0.05). Minimally invasive vitrectomy is fully qualified for the management of severe PDR, with maximized benefits. .
报告微创玻璃体切除术治疗重度增生性糖尿病视网膜病变（PDR）的疗效和安全性以及术前视网膜光凝对预后的影响。病例系列研究和队列研究。本研究纳入48例重度PDR患者（53只眼）。其中男性28例，女性20例。平均年龄为53.5岁（范围40.0至59.0岁）。根据是否进行术前视网膜光凝将患者分为两组。在微创玻璃体切除术理念的指导下，所有患者在使用27G +玻璃体切除系统进行标准平坦部玻璃体切除术3天前接受玻璃体内注射康柏西普。为缓解牵拉，将增生性纤维血管膜尽可能分成小的岛状。无需追求增生膜的完全切除。灵活应用27G +玻璃体切割器作为多功能膜切除工具，减少该设备进出眼内的频率。在主要区域进行眼内视网膜光凝。主要观察指标为最佳矫正视力（BCVA）和视网膜复位率，次要观察指标为术中和术后并发症。采用t检验、秩和检验和χ²检验进行统计学分析。所有患者均耐受玻璃体内康柏西普，未发生严重的术中和术后不良事件。术后BCVA值与术前相比有显著改善（χ² = 125.11，P < 0.01）。平均logMAR BCVA从术前的1.90（1.30，2.30）改善至术后1周的1.00（0.70，1.90），术后1个月为0.8（0.5，1.3），术后3个月为0.7（0.40，1.20），术后6个月为0.70（0.40，1.20）。视功能随时间逐渐改善。术后，初次和最终复位率分别为92.5%（50/53）和96.2%（51/53）。2只眼出现眼压异常持续超过1周；5只眼玻璃体出血复发；4只眼（7.5%）发生视网膜脱离；未发生术后眼内炎、脉络膜脱离或切口相关视网膜裂孔。术前视网膜光凝组的术中和术后参数优于术前未光凝组，但差异无统计学意义（P > 0.05）。微创玻璃体切除术完全有资格用于重度PDR的治疗，且效益最大化。
