Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark.
Int Ophthalmol. 2022 Mar;42(3):757-763. doi: 10.1007/s10792-021-02041-3. Epub 2021 Oct 8.
Proliferative diabetic retinopathy (PDR) can be treated by retinal photocoagulation, but in some cases, the treatment is initiated too late or is insufficient so that the disease advances to a stage requiring vitrectomy. There is a need to identify risk factors that can predict if patients with PDR will develop complications in need for vitrectomy.
Survival analysis with death as competing risk was used to study systemic risk factors for PDR progression to a complication in need for vitrectomy in right eyes of all 1288 diabetic patients from the Aarhus area, Denmark, who had developed proliferative retinopathy in the right eye during the 25 years period from 1 July 1994 until 1 July 2019.
The overall cumulative incidence of reaching a vitrectomy end point in the right eye was 24.1% (n = 311). In 9.3% (n = 120) of the patients where vitrectomy had been performed together with the first photocoagulation, the age of onset of diabetes was significantly higher (p < 0.0001), the diabetes duration longer (p < 0.035) and BMI higher (p < 0.01) than in the patients who had been vitrectomized later than the first photocoagulation. The risk for vitrectomy was significantly increased by high variability of HbA1c before the development of PDR (p < 0.0001), but not by other parameters known to increase the risk for developing PDR.
Increasing variability of HbA1c before the development of PDR increases the risk for progression to a complication in need of vitrectomy. The need for vitrectomy is unaffected by other risk factors known to increase the risk for developing PDR.
增生性糖尿病视网膜病变（PDR）可通过视网膜光凝术治疗，但在某些情况下，治疗开始得太晚或不足，以至于疾病进展到需要玻璃体切除术的阶段。需要确定可以预测 PDR 患者是否会出现需要玻璃体切除术并发症的危险因素。
使用以死亡为竞争风险的生存分析来研究丹麦奥胡斯地区的 1288 名糖尿病患者的右眼的系统性危险因素，这些患者在 1994 年 7 月 1 日至 2019 年 7 月 1 日的 25 年期间右眼出现增生性视网膜病变。
右眼达到玻璃体切除术终点的总累积发生率为 24.1%（n=311）。在 9.3%（n=120）同时进行第一次光凝术和玻璃体切除术的患者中，糖尿病发病年龄显著较高（p<0.0001），糖尿病病程较长（p<0.035），BMI 较高（p<0.01）与后来进行玻璃体切除术的患者相比。在发生 PDR 之前，HbA1c 的变异性高（p<0.0001），则玻璃体切除术的风险显著增加，但其他已知增加 PDR 发病风险的参数则没有。
在发生 PDR 之前，HbA1c 的变异性增加会增加进展为需要玻璃体切除术并发症的风险。其他已知增加 PDR 发病风险的因素不会影响玻璃体切除术的需求。
