Gershoni Assaf, Barayev Edward, Jbara Doha, Hadayer Amir, Axer-Siegel Ruth, Dotan Assaf, Gal-Or Orly, Tuuminen Raimo, Ehrlich Rita
Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Med (Lausanne). 2022 Sep 30;9:978346. doi: 10.3389/fmed.2022.978346. eCollection 2022.
To compare intra- and postoperative complications in combined phacoemulsification and pars plana vitrectomy surgeries performed in patients with non-proliferative diabetic retinopathy (NPDR) vs. proliferative diabetic retinopathy (PDR).
Retrospective, case series of patients with diabetic retinopathy who underwent combined phacovitrectomy surgery between 2008 and 2017. We compared intraoperative complications including posterior capsular rupture and retinal tear, and postoperative complications including corneal edema, macular edema (ME), epiretinal membrane (ERM), neovascular glaucoma and persistent inflammation.
A total of 104 eyes of 104 patients were included in this study. Twenty-four eyes (23.1%) were categorized as NPDR and 80 eyes (76.9%) as PDR. The most common indications for surgery in the NPDR group were ERM (67%) and rhegmatogenous retinal detachment (12.5%), while in the PDR group, indications were vitreous hemorrhage (56%) and tractional retinal detachment (19%). The most common intraoperative complication was retinal tear (8% in NPDR and 19% in PDR, = 0.195) and postoperative complication was ME (29% in NPDR and 26% in PDR, = 0.778). There were no statistically significant differences in intra- and postoperative complication rates between the NPDR and PDR groups, even after adjusting for confounders; patient age at surgery and indication for surgery.
After combined phacovitrectomy in NPDR and PDR patients, new-onset ME was found in about a quarter of eyes in both groups. Intraoperative anti-VEGF or steroid administration, and intense postoperative anti-inflammatory medication and follow-up should be regarded after phacovitrectomy regardless of the DR level.
比较非增殖性糖尿病视网膜病变（NPDR）患者与增殖性糖尿病视网膜病变（PDR）患者在白内障超声乳化吸除联合玻璃体切除术手术中及术后的并发症。
对2008年至2017年间接受白内障玻璃体联合手术的糖尿病视网膜病变患者进行回顾性病例系列研究。我们比较了术中并发症，包括后囊膜破裂和视网膜裂孔，以及术后并发症，包括角膜水肿、黄斑水肿（ME）、视网膜前膜（ERM）、新生血管性青光眼和持续性炎症。
本研究共纳入104例患者的104只眼。24只眼（23.1%）被归类为NPDR，80只眼（76.9%）为PDR。NPDR组最常见的手术指征是ERM（67%）和孔源性视网膜脱离（12.5%），而PDR组的手术指征是玻璃体积血（56%）和牵拉性视网膜脱离（19%）。最常见的术中并发症是视网膜裂孔（NPDR组为8%，PDR组为19%，P = 0.195），术后并发症是ME（NPDR组为29%，PDR组为26%，P = 0.778）。即使在调整混杂因素（手术时患者年龄和手术指征）后，NPDR组和PDR组在术中及术后并发症发生率上也没有统计学显著差异。
NPDR和PDR患者白内障玻璃体联合手术后，两组中约四分之一的眼出现了新发ME。无论糖尿病视网膜病变程度如何，白内障玻璃体切除术后均应考虑术中抗血管内皮生长因子或类固醇给药，以及术后强化抗炎药物治疗和随访。
