Xu Mingpeng, Li Bo, Li Chenxin, Chai Peiwei, Qiu Qinghua, Zheng Zhi, Chen Qian, Luo Dawei, Xu Xiaofang, Zhou Chuandi
Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ophthalmology, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Int J Retina Vitreous. 2024 Oct 10;10(1):74. doi: 10.1186/s40942-024-00593-x.
Vision-threatening diabetic retinopathy (VTDR) included severe non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR) and clinically significant diabetic macular edema (DME). To compare the axial length (AL) and assess its influence on VTDR across different ages.
A retrospective cohort study. Medical chart review was performed in 736 consecutive patients with VTDR. The patients were divided into young (≤ 45 years) and elderly group (> 45 years) based on their age at the diagnosis of VTDR. After at least one year of standardized treatments, all eligible patients were followed up. The main outcome measures included the presence of tractional retinal detachment (TRD) involving foveal, final best-corrected visual acuity (BCVA), the development of neovascular glaucoma (NVG), and recurrent vitreous hemorrhage (VH) post-vitrectomy. ALs were compared between two age groups. The impact of AL on clinical outcomes was determined by logistic analyses after controlling for systemic parameters.
The study included 144 patients ≤ 45 years and 592 patients > 45 years. Young patients had significantly longer AL than elderly participants (23.9 mm vs 23.0 mm, p < 0.001). Over a median follow-up of 25.9 months, a larger proportion of young patients developed TRD (34.7% vs 16.2%, p < 0.001) and recurrent VH (18.6% vs 10.3%, p = 0.040) than elderly patients. In elderly group, longer AL is an independent protective factor in preventing TRD (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.4-0.7; P < 0.001). However, this beneficial effect was not observed in young patients.
Young patients with VTDR exhibited significantly longer AL but more aggressive clinical signs with compromised prognosis. In elderly group, a longer AL independently reduced the risk of TRD, while this protective effect did not exist for young patients.
威胁视力的糖尿病视网膜病变（VTDR）包括严重非增殖性糖尿病视网膜病变（NPDR）、增殖性糖尿病视网膜病变（PDR）和具有临床意义的糖尿病黄斑水肿（DME）。比较不同年龄组的眼轴长度（AL），并评估其对VTDR的影响。
一项回顾性队列研究。对736例连续的VTDR患者进行病历审查。根据VTDR诊断时的年龄将患者分为年轻组（≤45岁）和老年组（>45岁）。在至少一年的标准化治疗后，对所有符合条件的患者进行随访。主要观察指标包括累及黄斑的牵拉性视网膜脱离（TRD）的存在情况、最终最佳矫正视力（BCVA）、新生血管性青光眼（NVG）的发生情况以及玻璃体切除术后复发性玻璃体出血（VH）情况。比较两个年龄组的AL。在控制全身参数后，通过逻辑分析确定AL对临床结局的影响。
该研究纳入了144例年龄≤45岁的患者和592例年龄>45岁的患者。年轻患者的AL显著长于老年参与者（23.9mm对23.0mm，p<0.001）。在中位随访25.9个月期间，年轻患者发生TRD（34.7%对16.2%，p<0.001）和复发性VH（18.6%对10.3%，p=0.040）的比例高于老年患者。在老年组中，较长的AL是预防TRD的独立保护因素（比值比[OR]，0.5；95%置信区间[CI]，0.4 - 0.7；P<0.001）。然而，在年轻患者中未观察到这种有益效果。
VTDR年轻患者的AL显著更长，但临床体征更具侵袭性，预后较差。在老年组中，较长的AL独立降低了TRD的风险，而年轻患者不存在这种保护作用。
