气体填充预防糖尿病玻璃体切割术后玻璃体积血：一项随机临床试验。
Gas Tamponade for the Prevention of Postoperative Vitreous Hemorrhaging After Diabetic Vitrectomy: A Randomized Clinical Trial.
机构信息
From Instituto de la Visión- Hospital La Carlota, Montemorelos, Nuevo León, México (R.B.R, J.C.V, C.R.R); Panhandle Eye Group, Amarillo, TX, USA (R.B.R, S.W.R); Texas Tech University Health Science Center, Amarillo, TX, USA (R.B.R, S.W.R); Southwest Retina Specialists, Amarillo, TX, USA (R.B.R).
From Instituto de la Visión- Hospital La Carlota, Montemorelos, Nuevo León, México (R.B.R, J.C.V, C.R.R).
出版信息
Am J Ophthalmol. 2022 Oct;242:173-180. doi: 10.1016/j.ajo.2022.06.015. Epub 2022 Jun 25.
PURPOSE
To compare vitreous substitution with sulfur hexafluoride (SF6) gas to balanced salt solution (BSS) for the prevention of postoperative vitreous hemorrhage (VH) in proliferative diabetic retinopathy (PDR) patients undergoing pars plana vitrectomy (PPV) for the indication of non-clearing VH.
METHODS
One hundred forty-four PDR subjects requiring PPV for the indication of non-clearing VH were enrolled into the trial. Subjects were prospectively randomized into 1 of 2 vitreous substitution groups: Group A subjects underwent 20% to 30% SF6 gas tamponade, whereas Group B subjects underwent vitreous substitution with BSS. The primary outcome was the incidence of postoperative VH during the 6-month trial period. Secondary outcomes were unplanned PPV for VH and best corrected visual acuity (BCVA) at 6-months follow-up.
RESULTS
Ninety-six subjects underwent randomization and completed 6-months follow-up. Postoperative VH during the trial period occurred in 6 of 54 subjects in Group A (SF6) (11.1%) and 14 of 42 in Group B (BSS) (33.3%) (P = .008). Unplanned PPV during the trial period for postoperative VH occurred in 2 of 54 in Group A (3.7%) and 6 of 42 in Group B (14.2%) (P = .06). The mean BCVA was not significantly different at 6-months follow-up between groups (P = .58).
CONCLUSIONS
This trial indicates that vitreous substitution with SF6 gas lowers the incidence of postoperative VH compared with BSS in PDR subjects undergoing PPV for the indication of non-clearing VH at 6-months follow-up. Specialists may consider SF6 gas tamponade during PPV as a means of helping reduce postoperative VH in this patient population. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
目的
比较在增殖型糖尿病视网膜病变（PDR）患者行玻璃体切割术（PPV）治疗非吸收性玻璃体积血（VH）适应证中，使用六氟化硫（SF6）气体与平衡盐溶液（BSS）玻璃体替代物预防术后 VH 的效果。
方法
本试验纳入 144 例因非吸收性 VH 而需要行 PPV 的 PDR 患者。患者前瞻性随机分为 2 种玻璃体替代物组之一：A 组患者接受 20%~30%SF6 气体填充，B 组患者接受 BSS 玻璃体替代物。主要转归为 6 个月试验期间术后 VH 的发生率。次要转归为 VH 计划性外的 PPV 和 6 个月随访时的最佳矫正视力（BCVA）。
结果
96 例患者接受随机分组并完成 6 个月随访。试验期间，A 组（SF6）54 例患者中有 6 例（11.1%）发生术后 VH，B 组（BSS）42 例患者中有 14 例（33.3%）发生术后 VH（P=0.008）。试验期间 VH 计划性外的 PPV 在 A 组发生 2 例（3.7%），B 组发生 6 例（14.2%）（P=0.06）。两组患者在 6 个月随访时的平均 BCVA 无显著差异（P=0.58）。
结论
该试验表明，与 BSS 相比，SF6 气体玻璃体替代物可降低 PDR 患者在 6 个月随访时因非吸收性 VH 而行 PPV 术后 VH 的发生率。在这种患者人群中，专家可考虑在 PPV 中使用 SF6 气体填塞来帮助减少术后 VH。注：本文的发表由美国眼科学会赞助。
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