在糖尿病玻璃体切除术中行巩膜光凝术至锯齿缘以预防复发性玻璃体积血。

Photocoagulation Up to Ora Serrata in Diabetic Vitrectomy to Prevent Recurrent Vitreous Hemorrhage.

机构信息

Department of Ophthalmology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Korea.

JC Bit Somang Eye Clinic, Seoul, Korea.

出版信息

Korean J Ophthalmol. 2023 Dec;37(6):477-484. doi: 10.3341/kjo.2023.0066. Epub 2023 Oct 25.

DOI:10.3341/kjo.2023.0066

PMID:37899285

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10721404/

Abstract

PURPOSE

To evaluate the role of performing photocoagulation up to ora serrata during vitrectomy in preventing recurrent vitreous hemorrhage (VH) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR).

METHODS

This retrospective, nonrandomized study included 60 eyes from 60 patients who had undergone PPV for VH due to PDR. These patients were divided into two groups: group 1, those who underwent photocoagulation up to ora serrata using the scleral indentation technique during surgery; and group 2, those who did not undergo scleral indentation when photocoagulation and underwent photocoagulation up to vortex veins. Their hospital records were analyzed to investigate the recurrence rate of VH, the time until recurrence of VH after surgery, logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) measured before surgery and at 1, 2, and 3 years after surgery, and the occurrence of complications such as neovascular glaucoma (NVG) during follow-up.

RESULTS

Group 1 exhibited lower recurrence rate of VH (2 of 30 [6.7%] vs. 10 of 30 [33.3%], p = 0.01) and lower occurrence of postoperative NVG (2 of 30 [6.7%] vs. 8 of 30 [26.7%], p = 0.038) compared with group 2. There were no statistically significant differences in logMAR BCVA measured at 1, 2, and 3 years between the two groups (at 1 year: 0.54 ± 0.43 vs. 0.54 ± 0.44, p = 0.954; at 2 years: 0.48 ± 0.47 vs. 0.55 ± 0.64, p = 0.235; at 3 years: 0.51 ± 0.50 vs. 0.61 ± 0.77, p = 0.200). Logistic regression analysis showed that among several factors that could affect recurrence rate of VH, only range of photocoagulation performed was a statistically significant factor (odds ratio, 0.119; 95% confidence interval, 0.022-0.659; p = 0.015).

CONCLUSIONS

Photocoagulation treatment over a wider range with scleral indentation could be a beneficial adjunct procedure for preventing postoperative recurrent VH following diabetic vitrectomy.

摘要

目的

评估在玻璃体切除术中行巩膜扣压式光凝术至锯齿缘的作用，以预防增殖性糖尿病视网膜病变（PDR）患者行玻璃体切除术（PPV）后发生复发性玻璃体积血（VH）。

方法

本回顾性、非随机研究纳入了 60 例因 PDR 所致 VH 而行 PPV 的患者的 60 只眼。这些患者分为两组：组 1 为术中采用巩膜压陷技术行巩膜扣压式光凝术至锯齿缘的患者；组 2 为未行巩膜压陷时行光凝术且光凝至涡静脉的患者。分析其住院病历，以调查 VH 复发率、术后 VH 复发时间、术前及术后 1、2 和 3 年时最小分辨角对数（logMAR）最佳矫正视力（BCVA）、随访期间新生血管性青光眼（NVG）等并发症的发生情况。

结果

与组 2 相比，组 1 的 VH 复发率较低（2/30[6.7%] vs. 10/30[33.3%]，p=0.01），术后 NVG 的发生率较低（2/30[6.7%] vs. 8/30[26.7%]，p=0.038）。两组患者在术后 1、2 和 3 年时的 logMAR BCVA 测量值无统计学差异（术后 1 年：0.54±0.43 比 0.54±0.44，p=0.954；术后 2 年：0.48±0.47 比 0.55±0.64，p=0.235；术后 3 年：0.51±0.50 比 0.61±0.77，p=0.200）。Logistic 回归分析显示，在可能影响 VH 复发率的多个因素中，仅光凝范围是一个有统计学意义的因素（比值比，0.119；95%置信区间，0.022-0.659；p=0.015）。