Patel Veshesh, Rohowetz Landon J, Pakravan Parastou, Kalavar Meghana, Yannuzzi Nicolas A, Sridhar Jayanth
Department of Ophthalmology, Bascom Palmer Eye Institute University of Miami, Miami, FL, USA.
Clin Ophthalmol. 2023 Feb 1;17:471-478. doi: 10.2147/OPTH.S400474. eCollection 2023.
To review clinical outcomes of patients with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) who underwent pars plana vitrectomy (PPV) with endolaser panretinal photocoagulation (PRP) without retinal detachment (RD) repair.
Retrospective chart review of the rate of postoperative clinical findings and visual acuity in patients with PDR from May 2014 to August 2021.
Pars plana vitrectomy with endolaser PRP was performed in 81 eyes of 81 patients (mean age of 62.1 ± 10.5 years). At a median follow-up of 18 months, mean Snellen best-corrected visual acuity (BCVA) significantly improved from 20/774 preoperatively to 20/53 at last follow-up ( < 0.001). Postoperative complications and clinical findings included VH (12.3%), diabetic macular edema (DME) (12.3%), ocular hypertension (8.6%), RD (4.9%), and need for additional PPV (6.2%). Eyes with PRP performed within 6 months before surgery had a lower frequency of developing postoperative VH (5.3%) compared to eyes that received PRP more than 6 months before surgery (27.3%, = 0.04). Eyes that received preoperative anti-vascular endothelial growth factor (VEGF) treatment (2.0%) had a lower frequency of postoperative VH compared to eyes that did not receive anti-VEGF treatment (14.3%, = 0.04). Eyes that received intraoperative sub-tenon triamcinolone acetonide developed postoperative DME (4.0%) less frequently than eyes that did not receive sub-tenon triamcinolone acetonide (26.7%, = 0.04).
In patients with PDR and VH, PPV with PRP yielded significant improvements in visual acuity and resulted in overall low rates of recurrent postoperative VH. Preoperative anti-VEGF and PRP laser treatment were associated with lower rates of postoperative VH. Furthermore, intraoperative use of sub-tenon triamcinolone acetonide was associated with a lower rate of postoperative DME. Pars plana vitrectomy with endolaser PRP in conjunction with the aforementioned pre- and intraoperative therapies is an effective treatment for patients with PDR and VH.
回顾接受不伴有视网膜脱离修复的玻璃体切割联合全视网膜激光光凝术（PPV联合PRP）的增殖性糖尿病视网膜病变（PDR）和玻璃体出血（VH）患者的临床结局。
对2014年5月至2021年8月期间PDR患者的术后临床检查结果和视力进行回顾性图表分析。
81例患者的81只眼接受了玻璃体切割联合PRP（平均年龄62.1±10.5岁）。中位随访18个月时，平均Snellen最佳矫正视力（BCVA）从术前的20/774显著提高至末次随访时的20/53（P<0.001）。术后并发症和临床检查结果包括VH（12.3%）、糖尿病性黄斑水肿（DME）（12.3%）、高眼压（8.6%）、视网膜脱离（RD）（4.9%）以及需要再次进行PPV（6.2%）。术前6个月内接受PRP治疗的眼术后发生VH的频率（5.3%）低于术前6个月以上接受PRP治疗的眼（27.3%，P=0.04）。术前接受抗血管内皮生长因子（VEGF）治疗的眼（2.0%）术后VH的发生率低于未接受抗VEGF治疗的眼（14.3%，P=0.04）。术中接受球周注射曲安奈德的眼术后发生DME的频率（4.0%）低于未接受球周注射曲安奈德的眼（26.7%，P=0.04）。
对于PDR和VH患者，PPV联合PRP可显著提高视力，且术后VH复发率总体较低。术前抗VEGF和PRP激光治疗与术后VH发生率较低相关。此外，术中使用球周注射曲安奈德与术后DME发生率较低相关。玻璃体切割联合PRP并结合上述术前和术中治疗方法是治疗PDR和VH患者的有效方法。
