ObjectiveTo evaluate the factors that may influence the possibility of early hemorrhage after vitrectomy with silicon oil tamponade for proliferative diabetic retinopathy (PDR).MethodsSixty-seven eyes of 60 patients of PDR who received vitrectomy and silicon oil filled in Department of Ophthalmology, China-Japan Friendship Hospital during January 2014 and May 2017 were included in this study. There were 34 males and 26 females, with the mean age of 51.3±12.5 years. Groups were divided depending on the degree of postoperative hemorrhage in 3 days: non-hemorrhage group (NH group) and hemorrhage Group (H group) composed of two sub-group that were called slight hemorrhage (SH) and massive hemorrhage (MH) group. The treatment was conventional 25G or 27G pars plana vitrectomy combined with silicon oil tamponade. Forty eyes received phacoemulsification. The follow-up ranged from 8 to 16 months, with the mean follow-up of 11.2±5.6 months. The possible related factors of early hemorrhage after vitrectomy with silicon oil tamponade were analyzed. Independent t test, χ2 test and Fisher test were used in this study.Results55 eyes of 48 patients were in the NH group, while 12 eyes of 12 patients were in the H Group. There were statistical significances on the difference of age (t=−3.552, P=0.001), gender (P=0.052), hypertension (P=0.021), HbA1c (t=2.187, P=0.033) and presence of neovascularization of iris (χ2= 6.414, P=0.011), but there was no difference on diabetes duration (t=−0.451, P=0.654). Of the 12 patients in the H group, 7 were in the SH group and 5 were in the MH group. The MH group had a significantly higher HbA1c level (7.8±1.1)% compared with the SH Group (9.7±0.7)%, the difference was statistical significant (t=−3.256, P=0.009). Higher systolic blood pressure of MH group 186±7 mmHg (1 mmHg=0.133 kPa) acquired during operation was observed compared with SH Group 153±18 mmHg, the difference was statistical significant (t=−3.894, P=0.003). There was no statistical significances on the difference of age (t=1.954), gender, hypertension duration (t=−1.787), diabetes duration (t=−1.079), fasting blood-glucose (t=−0.361), diastolic blood pressure during operation (t=−0.811) between the two groups (P＞0.05).ConclusionsYounger age, history of hypertension, presence of neovascularization of iris, higher level of HbA1c may predict greater possibility to cause early hemorrhage after vitrectomy with silicon oil tamponade for PDR. The patients with high level of HbA1c and high systolic pressure during the operation are more likely to undergo massive hemorrhage and secondary glaucoma.
ObjectiveTo investigate the risk factors for neovascular glaucoma (NVG) after vitrectomy in proliferative diabetic retinopathy (PDR) patients. MethodsThree hundred and one patients (301 eyes) with PDR who underwent vitrectomy between January 2008 and December 2013 in our hospital were retrospectively evaluated. Risk factors for NVG after vitrectomy were identified by multivariate Logistic regression analysis. ResultsTwelve of 301 patients (4.0%) developed postoperative NVG in 2 to 18 months after vitrectomy. The incidence of postoperative NVG peaked in 2 to 6 months after vitrectomy (7 eyes, 58.3%). Logistic regression analysis showed that postoperative retinal detachment was a significant risk factor for postoperative NVG in eyes with PDR (P < 0.001). Eyes with postoperative retinal detachment were more likely to develop NVG after vitrectomy than those without postoperative retinal detachment (OR=17.826). Gender, age, duration of diabetes, preoperative serum creatinine levels, glycated hemoglobin levels, preoperative intraocular pressure, preoperative lens status, combined phacoemulsification surgery and tamponade were not associated with postoperative NVG (P > 0.05). ConclusionPostoperative retinal detachment is a major risk factor for NVG after vitrectomy in PDR.
The occurrence of high intraocular pressure (IOP) after vitrectomy for diabetic retinopathy (DR) is related to many factors, including the type and stage of DR, macular detachment, surgical methods, and the type of ocular tamponade. Early high IOP occurred mainly due to laser photocoagulation, inflammatory response, improper ocular tamponade, residual viscoelastic agents and ciliary body dysfunction. In addition to the above reasons, early-middle stage high IOP is also related to tamponade gas expansion peak, encircling scleral buckle and hyphema. The major reason for middle-stage high IOP is hyphema and silicon oil in anterior chamber. The reasons for late-stage high IOP are glaucoma, silicone oil emulsification, long-term use of glucocorticoid, and iris incision closure. Most high IOP can be controlled by proper treatment such as stopping use of glucocorticoid, anti-glaucoma eye drops and surgeries. But there are still a small number of patients with unexplained refractory high IOP, the mechanism need to be further explored.
Objective To observe the short-term intraocular pressure after 25G+ pars plana vitrectomy (PPV) and analyze the possible influencing factors in rhegmatogenous retinal detachment (RRD) and proliferative diabetic retinopathy (PDR) eyes. Methods This is a retrospective case-control study. A total of 160 patients (163 eyes) of RRD and PDR who underwent 25G+ PPV were enrolled in this study. There were 88 males (89 eyes) and 72 females (74 eyes), with the mean age of (50.37±13.24) years. There were 90 patients (92 eyes) with RRD (the RRD group) and 70 patients (74 eyes) with PDR (the PDR group). Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were performed on all the patients. The BCVA was ranged from hand motion to 0.6. The average IOP was (12.61±4.91) mmHg (1 mmHg=0.133 kPa). There were significant differences in crystalline state (χ2=9.285, P=0.009), IOP (χ2=58.45, P=0.000), history of PPV (χ2=4.915, P=0.027) and hypertension (χ2=24.018, P=0.000), but no significant difference in sex (χ2=0.314, P=0.635) and age (χ2=5.682, P=0.056) between the two groups. A non-contact tonometer has been used to measure IOP on postoperative day 1 and 3. The postoperative IOP distribution has been divided into five groups: severe ocular hypotension (≤5 mmHg), mild ocular hypotension (6 - 9 mmHg), normal (10 - 21 mmHg), mild ocular hypertension (22 - 29 mmHg), severe ocular hypertension (≥30 mmHg). Logistic regression analysis has been used to analyze the risk and protective factors. Results On the first day after surgery, there were 21 eyes (12.9%) in mild ocular hypotension, 96 eyes (58.9%) in normal, 22 eyes (13.4%) in mild ocular hypertension and 24 eyes (14.7%) in severe ocular hypertension. On the first day after surgery, there were 18 eyes (11.0%) in mild ocular hypotension, 117 eyes (71.7%) in normal, 23 eyes (14.1%) in mild ocular hypertension and 5 eyes (3.1%) in severe ocular hypertension. There was no significant difference of IOP distribution between the two groups (Z=−1.235, −1.642; P=0.217, 0.101). The results of logistic regression analysis showed that silicone tamponade was a risk factor for ocular hypertension in PDR eyes on the first day after surgery [odds ratio (OR)=15.400, 95% confidence interval (CI) 3.670 - 64.590; P＜0.001], while intraocular lens was the risk factor for ocular hypotension in PDR eyes on third day after surgery (OR=19.000, 95%CI 1.450 - 248.2; P=0.025). As for RRD eyes, the ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=3.755, 95%CI 1.088 - 12.955; P=0.036). For all eyes, silicone tamponade (OR=0.236, 95%CI 0.070 - 0.797), air tamponade (OR=0.214, 95%CI 0.050 - 0.911) and inert gas tamponade (OR=0.092, 95%CI 0.010 - 0.877) were protective factors for ocular hypotension on the first day after surgery (P=0.020, 0.037, 0.038); silicone tamponade was protective factor for ocular hypotension on the third day after surgery (OR=0.249, 95% CI 0.066 - 0.94, P=0.040); while aphakic eyes was the risk factor for ocular hypotension on third day after surgery (OR=7.765, 95% CI 1.377 - 43.794, P=0.020). The ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=4.034, 95% CI 1.475 - 11.033, P=0.007). Conclusions The abnormal IOP is common after 25G+ PPV with a rate from 28.3% to 31.1%. Silicone tamponade, air tamponade and inert gases tamponade are protective factors for postoperative ocular hypotension, aphakic eye is risk factor for postoperative ocular hypotension. Ocular hypotension before surgery and silicone oil tamponade are risk factors for postoperative ocular hypertension.
Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
Objective To analyze the reasons, methods of treatment, and effects on prognosis of vitreous hemorrhage after vitrectomy in patients with diabetic retinopathy. Methods The clinical data of 98 patients (122 eyes) with diabetic retinopathy (VI stage) who had undergone vitrectomy were retrospectively analyzed. Results Post-vitrectomy vitreous hemorrhage (gt;grade 2) was found in 25 eyes with the occurrence of 20.5%, in which the hemorrhage occurred 1 week after the surgery in 8 eyes, 1 week to 1 month in 6 eyes, and more than 1 month in 11 eyes. In the 25 eyes, C3F8 tamponade eyes occupied 31.1%, silicone oil tamponade eyes occupied 6.1%, air tamponade eyes occupied 33.3%, and infusion solution tamponade eyes occupied 26.3%. Peripheral fibrovascular proliferation was found in 9 eyes. In the 3 eyes with silicone oil tamponade, the hemorrhage was absorbed in 2, and epiretinal membrane was found in 1 which was moved when the silicon oil was taken out. In the 22 eyes without silicone oil tamponade, the hemorrhage was absorbed in 6 and aggravated in 2 without any timely treatment, neovascular glaucoma occurred in 1, and wide vitreo-retinal proliferation and retinal detachment was observed in 1 with the visual acuity of no light perception. Operations such as fluid-air exchange, vitrectomy were performed on 14 eyes 2 weeks after the hemorrhage absorption stopped. Recurrent vitreous hemorrhage was not found in 12 eyes after single operation. At the end of the follow up period, the visual acuity was no light perception in 3 eyes, hand moving in 2 eyes, counting finger-0.1 in 10 eyes, under 0.3 in 4 eyes, and over 0.3 in 6 eyes. Conclusion Most of the patients with vitreous hemorrhage after vitrectomy due to DR had peripheral fibrovascular proliferation. The visual prognosis after re-operation is good. (Chin J Ocul Fundus Dis,2007,23:241-243)
Complications of proliferative diabetic retinopathy have become the major indications of vitrectomy. The surgery, however, is not basically a causative therapy. The visual function after operation depends on the degree of retinal ischemia and damage induced. The surgery itself has a potential for severe complications. Therefore it is important to better understand the pathology and to master surgical strategy and techniques in order to improve surgical outcomes and reduce the surgical complications. (Chin J Ocul Fundus Dis,2007,231-233)