Analysis of related risk factors of vitreous hemorrhage after anti-vascular endothelial growth factor combined with vitrectomy for proliferative diabetic retinopathy

Q4 Medicine

中华眼底病杂志 Pub Date : 2020-02-25 DOI:10.3760/CMA.J.ISSN.1005-1015.2020.02.003

Feng Yanbing, Chenting Zhu, Yanyan He, Yongwei Zhu, Lijun Jiang, Weiling Luo, Yi-hua Wu, Weng Wenqing

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Abstract

Objective To observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR). Methods Retrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data. Results Of the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH (χ2=5.741, 8.103; P 0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH (rs=0.208, 0.229, 0.240, 0.285; P<0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery (OR=5.175, 13.915; P<0.05). Conclusion Fundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV. Key words: Vitreous hemorrhage; Diabetic retinopathy; Vitrectomy; Angiogenesis inhibitors/therapeutic use; Root cause analysis

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抗血管内皮生长因子联合玻璃体切除术治疗增殖性糖尿病视网膜病变后玻璃体出血的相关危险因素分析

目的观察和分析增生性糖尿病视网膜病变（PDR）患者应用抗VEGF药物联合玻璃体切除术（PPV）后玻璃体再出血（PVH）的相关危险因素。方法回顾性分析研究。2017年4月至2018年7月，在嘉兴眼科医院确诊并接受抗VEGF药物联合25G PPV治疗的87例PDR患者的100眼纳入研究。其中男性44只眼，女性49只眼，56只眼。年龄26～83岁，平均年龄57.72±8.82岁。所有患者均为2型糖尿病，糖尿病平均病程10.84±6.03年。所有受影响的眼睛都由同一位医生在睫状体平坦部分的标准三通道25G PPV下使用非接触广角透镜进行辅助。手术前5至7天，玻璃体内注射雷珠单抗或康柏西普0.05毫升（10毫克/毫升）。观察PVH的发生率。PVH患者的年龄、糖尿病持续时间、术前视力、术前平均空腹血糖和餐后平均血糖、术前收缩压和舒张压、术前激光治疗、术中摘除晶状体、术中眼内填充、术中视网膜激光点，分析术中眼底病变（增生膜、视网膜出血、血管闭塞、增生性视网膜牵引、视网膜裂孔、视网膜脱离、渗出、新生血管），找出PVH的病因。对数据进行Spearman二元相关分析和二元逻辑回归分析。结果87例患者100眼中，PVH发生率17眼（17%）。PVH患者和非PVH患者术中血管闭塞和增生性牵引的眼数差异有统计学意义（χ2=5.741，8.103；P 0.05）。Spearman双变量相关分析显示，视力低下、空腹血糖水平控制不佳的患者，术中血管闭塞和增生性视网膜牵引是PVH的相关危险因素（rs=0.2080.229200.285；P<0.05）。二元逻辑回归分析表明，眼底血管闭塞和增殖性视网膜牵引可能是术中PVH的独立危险因素（OR=5.175，13.915；P<0.05）PPV中纤维血管膜增生引起的牵引可能是PDR患者在抗VEGF药物联合PPV后发生PVH的独立危险因素。关键词：玻璃体出血；糖尿病视网膜病变；玻璃体切除术；血管生成抑制剂/治疗用途；根本原因分析

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来源期刊

中华眼底病杂志 Medicine-Ophthalmology

CiteScore

0.40

自引率

0.00%

发文量

5383

期刊介绍： Chinese Journal of Ocular Fundus Diseases is the only scientific journal in my country that focuses on reporting fundus diseases. Its purpose is to combine clinical and basic research, and to give equal importance to improvement and popularization. It comprehensively reflects the leading clinical and basic research results of fundus disease disciplines in my country; cultivates professional talents in fundus disease, promotes the development of fundus disease disciplines in my country; and promotes academic exchanges on fundus disease at home and abroad. The coverage includes clinical and basic research results of posterior segment diseases such as retina, uveal tract, vitreous body, visual pathway, and internal eye diseases related to systemic diseases. The readers are medical workers and researchers related to clinical and basic research of fundus diseases. According to the journal retrieval report of the Chinese Institute of Scientific and Technological Information, the comprehensive ranking impact factor and total citation frequency of the Chinese Journal of Ocular Fundus Diseases have been among the best in the disciplines of ophthalmology, otolaryngology, and ophthalmology in my country for many years. The papers published have been included in many important databases at home and abroad, such as Scopus, Peking University Core, and China Science Citation Database (CSCD).