Cao Xiaolu, Jia Peipei, Qiao Xiulian, Gao Beibei, Wang Fuyin
Hebei Ophthalmology Key lab, Hebei Eye Hospital, Xingtai, 054000, Hebei Province, China.
BMC Ophthalmol. 2025 Mar 28;25(1):159. doi: 10.1186/s12886-025-03984-2.
This study aims to investigate factors and prognosis of neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).
A total of 200 PDR patients with 225 eyes from May 2017 to January 2023 were retrospectively analyzed, including 115 males (128 eyes) and 85 females (97 eyes) with ages ranging from 30 to 75 years. All 25G PPV surgeries were completed by the same experienced chief physician. During the surgery, the anterior retinal fibrous vascular membrane was fully removed, and laser panretinal photocoagulation (PRP) was performed, phacoemulsification was combined in 114 patients. The average postoperative follow-up time was 10.65 ± 6.84 months and occurrence of NVG was recorded. Potential risk factors of NVG included age, glycated hemoglobin (HbAlc), blood urea nitrogen (BUN), severity of preoperative fundus lesion, preoperative treatment of anti-vascular endothelial growth factor (VEGF), preoperative PRP application, combination of phacoemulsification.
Among the total 225 eyes, 15 (6.7%) eyes developed NVG 1-12 months after surgery, including 11 cases within 6 months. Incidence of NVG was associated with age (t=-3.974), preoperative treatment of anti-VEGF (χ = 5.706), preoperative PRP application (χ = 4.744), comorbid tractional retinal detachment (TRD) (χ = 3.883), comorbid fibrovascular proliferation (FVP) (χ = 4.093), and combination of phacoemulsification (χ = 6.179), with all P values less than 0.05. On the other hand, no differences were found in HbAlc (t = 0.733) and BUN (t = 0.470), with both P values greater than 0.05. By the end of follow-up, all NVG cases after PPV underwent intravitreal injection of anti-VRGF drugs and supplementary retinal laser therapy, of which 8 patients had stable intraocular pressure control, 5 patients received drainage valve implantation surgery to control intraocular pressure, 1 patient abandoned surgery due to no light perception at presentation, and 1 patient underwent cyclophotocoagulation. The postoperative best corrected visual acuity (BCVA) after NVG was statistically significant compared with that before NVG (P < 0.05).
Occurrence of NVG in PDR was related to preoperative PRP and anti-VEGF, and might further have impact on prognosis. In addition, comprehensive consideration of patient's age, severity of preoperative fundus lesion and appropriate surgical method (i.e., whether combined with phacoemulsification) could be protective factors of NVG.
ClinicalTrials.gov, NCT02399887, Registered 25 March 2019.
本研究旨在探讨增殖性糖尿病视网膜病变（PDR）患者行玻璃体切割术（PPV）后新生血管性青光眼（NVG）的相关因素及预后情况。
回顾性分析2017年5月至2023年1月期间共200例PDR患者的225只眼，其中男性115例（128只眼），女性85例（97只眼），年龄30至75岁。所有25G PPV手术均由同一位经验丰富的主任医师完成。手术过程中，充分切除视网膜前纤维血管膜，并进行全视网膜激光光凝（PRP），114例患者联合行超声乳化术。术后平均随访时间为10.65±6.84个月，并记录NVG的发生情况。NVG的潜在危险因素包括年龄、糖化血红蛋白（HbAlc）、血尿素氮（BUN）、术前眼底病变严重程度、术前抗血管内皮生长因子（VEGF）治疗、术前PRP应用、超声乳化术联合应用情况。
在总共225只眼中，15只眼（6.7%）在术后1至12个月发生NVG，其中6个月内发生11例。NVG的发生率与年龄（t=-3.974）、术前抗VEGF治疗（χ=5.706）、术前PRP应用（χ=4.744）、合并牵拉性视网膜脱离（TRD）（χ=3.883）、合并纤维血管增殖（FVP）（χ=4.093）以及超声乳化术联合应用情况（χ=6.179）有关，所有P值均小于0.05。另一方面，HbAlc（t=0.733）和BUN（t=0.470）方面未发现差异，P值均大于0.05。随访结束时，所有PPV术后发生NVG的病例均接受了玻璃体内注射抗VRGF药物及补充视网膜激光治疗，其中8例患者眼压控制稳定，5例患者接受了引流阀植入手术以控制眼压，1例患者因就诊时无光感放弃手术，1例患者接受了睫状体光凝术。NVG术后最佳矫正视力（BCVA）与术前相比差异有统计学意义（P<0.05）。
PDR患者中NVG的发生与术前PRP和抗VEGF有关，且可能进一步影响预后。此外，综合考虑患者年龄、术前眼底病变严重程度及合适的手术方式（即是否联合超声乳化术）可能是NVG的保护因素。
ClinicalTrials.gov，NCT02399887，2019年3月25日注册。
