ABSTRACT
Objective:To investigate the risk factors of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods:A case-control study was conducted.A total of 1 848 consecutive PDR patients (1 848 eyes) with vitreous hemorrhage receiving first pars plana vitrectomy (PPV) in Tianjin Medical University Eye Hospital from June 2012 to May 2019 were enrolled.There were 979 males and 869 females, with the average age of (55.72±10.39) years.All of the enrolled eyes underwent standard three-channel PPV.The subjects were followed up for 6 to 24 months, with the mean follow-up of (379.34±231.28) days.The eyes were divided into PVH group and non-PVH group according to whether the PVH occurred or not.The PVH group were further divided into early PVH group and late PVH group according to the occurrence time of PVH.There were 170 (9.19%) of 1 848 eyes developed PVH after surgery, including 17.64%(30/170) of eyes with early PVH and 82.36% (140/170) of eyes with late PVH.The PVH occurred at 6 to 450 days after surgery.Baseline systemic parameters including sex, age, diabetes duration, preoperative glycosylated hemoglobin (HbA1c) level, and ocular parameters including whether or not performing panretinal photocoagnlation, whether or not receiving treatment of anti-vascular endothelial growth factor (VEGF) three days before operation, lens status, whether or not being combined with neovascularization of iris (NVI), as well as intraoperative ocular parameters including whether or not having neovascularization of disc (NVD) bleeding, whether or not being combined with cataract phacoemulsification, whether or not receiving postoperative anti-VEGF, were analyzed by multivariate logistic regression analysis to identify the risk factors of PVH after PPV in PDR patients with VH.This study adhered to the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2019KY[L]-09).Results:Multivariate logistic regression analysis revealed that age ( OR=0.940, P<0.01), preoperative high HbA1c level ( OR=1.878, P<0.01), combined with retinal vein occlusion (RVO) ( OR=8.310, P<0.01), diabetes diet to control blood glucose ( OR=3.030, P<0.01), diabetes duration ( OR=1.044, P<0.01), history of hypertension ( OR=1.802, P<0.01), nephropathy or cardiovascular or cerebrovascular diseases ( OR=18.377, P<0.01), preoperative NVI ( OR=7.488, P<0.01), not combined with phacoemulsification surgery ( OR=1.628, P=0.023), NVD bleeding ( OR=2.691, P<0.01), postoperative anti-VEGF treatment ( OR=0.181, P<0.01), postoperative air tamponade ( OR=1.901, P=0.024) were associated with PVH.There were no significant differences in baseline, ocular and intraoperative ocular parameters between early PVH and late PVH groups (all at P>0.05). Conclusions:Younger age, preoperative high HbA1c level, combined with RVO, diabetes diet to control diabetes, diabetes duration, history of hypertension, nephropathy or cardiovascular or cerebrovascular diseases, preoperative NVI, uncombined with cataract surgery, NVD bleeding, without postoperative intravitreal anti-VEGF injection, postoperative air tamponade are the potential risk factors of PVH after PPV for PDR patients with VH.
ABSTRACT
Background Lensectomy with anterior capsule preserving is still advisable under specific conditions during vitrectomy.Although lens epithelial cells were polished off during surgery,opacification in varying degrees could be observed.Understanding the composition of proliferative anterior capsule membrane is of an important clinical significance for the prevention and manegement.Objective This study was to investigate the management and pathology of the pupillary area membranous opacity underling preserved anterior capsule after lensectomy in diabetic eyes with silicone oil tamponade.Methods Twenty-three eyes of 21 patients with proliferative diabetic retinopathy (PDR) and cataract received vitrectomy combined with lensectomy preserved anterior capsule in China-Japan Friendship Hospital from January to December 2013,and the proliferative anterior capsular membrane specimens with the opacification grade C or D were obtained.The fibrotic membrane underlying anterior capsules were removed in order to make a clear optical area during the operation of silicone oil removal.The proliferative membrane at pupillary area was cut off by cutter probe for the eyes with the membrane attaching tightly or partial capsule laceration occurred.The available specimens were examined under the optical microscope and polarized microscope respectively after hemotoxylin and eosin staining,Van Gieson collagen staining,Masson collagen staining and Picrosirius staining.Results The proliferative fibrosis membranes were pilled to get a clear pupillary area in 15 eyes,with the successfully rate 65.2％ (15/23).In 14 eyes with degree C opacity,the proliferative fibrosis membranes were pilled in 9 eyes,with the successfully rate 64.3 ％ (9/14),and 5 eyes received anterior capsule cutthrough by cutter in pupillary area,with a diameter of 3-4 mm,and available specimens were obtained in 3 eyes.In 9 eyes with degree D opacity,the proliferative membranes were pilled in 6 eyes,with the successfully rate of 66.7％ (6/9),and 3 eyes underwent cut-through by cutter,and available specimens were obtained in 7 eyes.The best corrected visual acuity was obviously improved in 20 eyes and unchanged in 3 eyes after surgery.The histopathological examination showed fibroblasts,pigment particles and intracellular and extracellular vacuolus formation by hemotoxylin and eosin staining,fibril tissue with the pinke staining by Van Gieson,collage formation with green color by Masson staining in the specimens.Picrosirius staining plus polarization microscopy observation revealed that the collagen consisted of abundant type Ⅰ collagen with stronger reddish yellow color and small amount of type Ⅲ collagen with green color.Conclusions A combination of silicon oil removal with proliferative mambrane pelling is a available way to restore pupillary transparency in the eyes of PDR with cataract and silicone oil tamponade eyes.Proliferative residual lens epithelial cells,pigment epithelial cells and silicon oil granules are the main composition of opacity mambrane.The type Ⅰ collagen is dominant in proliferative collagen tissue.