2型糖尿病年轻与老年患者增殖性糖尿病视网膜病变并发症的临床特征及手术结果
Clinical Characteristics and Surgical Outcomes of Complications of Proliferative Diabetic Retinopathy in Young versus Older Patients with Type 2 Diabetes.
作者信息
Zhang Meng, Xu Gezhi, Ruan Lu, Huang Xin, Zhang Ting
机构信息
Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China.
Institute of Eye Research, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China.
出版信息
Diabetes Metab Syndr Obes. 2023 Jan 11;16:37-45. doi: 10.2147/DMSO.S382603. eCollection 2023.
PURPOSE
Proliferative diabetic retinopathy (PDR) is a leading vision-threatening disease. In this study, we investigated the clinical features of PDR and the surgical outcomes of its complications in patients with type 2 diabetes (T2D).
PATIENTS AND METHODS
We retrospectively reviewed the medical data of patients with T2D who underwent vitrectomy for PDR between January 2016 and June 2021. The patients were divided into two groups by age (young patients, < 45 years; older patients, ≥ 45 years).
RESULTS
There were 149 eyes (100 patients) in the young patient group and 315 eyes (256 patients) in the older patient group. The proportion of males and the proportion of patients requiring binocular surgery were much higher in the young patient group than in the older patient group ( = 0.005 and < 0.001, respectively). In the young patient group, 26.2% of eyes had active fibrovascular proliferation compared with only 11.4% in the older patient group ( < 0.001). The final best-corrected visual acuity (BCVA) was significantly improved relative to the preoperative BCVA in both groups ( < 0.001). After surgery, there were no significant differences in the incidence of postoperative neovascular glaucoma (NVG) or recurrent vitreous hemorrhage (VH) between the two groups. The incidence of postoperative recurrent retinal detachment was higher in the young patient group ( = 0.033). The risk factors associated with the visual outcomes in the young patient group included preoperative BCVA ( < 0.001), renal diseases ( = 0.001), postoperative NVG ( < 0.001), and recurrent VH ( = 0.028).
CONCLUSION
In this retrospective study, young patients who underwent vitrectomy for PDR had more severe clinical characteristics before vitrectomy. However, vitrectomy (combined with cataract surgery when necessary) achieved better final visual outcomes in young patients than in older patients with T2D.
目的
增殖性糖尿病视网膜病变（PDR）是一种主要的致盲性疾病。在本研究中，我们调查了2型糖尿病（T2D）患者PDR的临床特征及其并发症的手术治疗效果。
患者与方法
我们回顾性分析了2016年1月至2021年6月期间因PDR接受玻璃体切除术的T2D患者的医疗数据。根据年龄将患者分为两组（年轻患者，<45岁；老年患者，≥45岁）。
结果
年轻患者组有149只眼（100例患者），老年患者组有315只眼（256例患者）。年轻患者组男性比例和需要双眼手术的患者比例均显著高于老年患者组（分别为P = 0.005和P < 0.001）。年轻患者组中26.2%的眼有活跃的纤维血管增殖，而老年患者组仅为11.4%（P < 0.001）。两组患者最终的最佳矫正视力（BCVA）相对于术前BCVA均有显著改善（P < 0.001）。术后，两组患者新生血管性青光眼（NVG）或复发性玻璃体出血（VH）的发生率无显著差异。年轻患者组术后视网膜脱离复发率较高（P = 0.033）。年轻患者组与视力预后相关的危险因素包括术前BCVA（P < 0.001）、肾脏疾病（P = 0.001）、术后NVG（P < 0.001）和复发性VH（P = 0.028）。
结论
在这项回顾性研究中，因PDR接受玻璃体切除术的年轻患者在玻璃体切除术前具有更严重的临床特征。然而，玻璃体切除术（必要时联合白内障手术）在年轻患者中比在老年T2D患者中能取得更好的最终视力预后。
Zotero 插件