糖尿病性视网膜病变玻璃体切除术后渗出性视网膜脱离相关因素分析

发布时间：2018-03-22 10:11

本文选题：渗出性视网膜脱离(ERD)　切入点：玻璃体切除术(PPV)　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文意在研究增殖性糖尿病性视网膜病变(proliferative diabetic retinopathy PDR)在玻璃体切除术(pars plana vitrectomy PPV)后诱发渗出性视网膜脱离(exudative retinal detachment ERD)的相关因素。方法:入选患者为2015年12月到2016年12月就诊于吉林大学第二医院眼科中心眼底病科,因PDR于本医疗组行PPV手术的患者,排除标准为:患者有除糖尿病及高血压以外其他全身系统疾病者;有除白内障摘除、人工晶体植入术或全视网膜激光光凝术以外的其他眼科手术史者;有眼肿瘤、其他视网膜血管性疾病、葡萄膜炎、巩膜炎、眼外伤、先天性眼疾病等病史者。结果:在此期间,共有127名患者160眼符合标准入选,男性61例76眼(47.5%),女性66例84眼(52.5%)。其中有17眼(10.63%)于术后平均2天(1~3天)发现渗出性视网膜脱离,并伴有不同程度的渗出性脉络膜脱离,所有患者平均年龄为51.5岁(21-74岁)。分析的相关因素主要为:年龄、性别、舒张压、收缩压、血浆白蛋白浓度、术中视网膜激光光凝点数、眼轴长、是否曾行白内障摘除及人工晶体植入术、是否曾行视网膜激光光凝术、是否于术前行抗VEGF治疗、术后第1天眼压、术后第2天眼压、血肌酐、尿素氮。单因素分析后初步筛选出与ERD的发生可能存在相关性的因素为:血浆白蛋白浓度(P=0.017)、眼轴长(P=0.023)、白内障手术史(P=0.011)、术前抗VEGF治疗史(P=0.012)。上述四个因素经二元logistic分析后发现,与ERD的发生存在相关性的因素为:血浆白蛋白浓度(P=0.017)、眼轴长(P=0.013)、白内障手术史(P=0.032).且在本组病例中发生ERD的患者平均血浆白蛋白浓度为38.88g/L,平均眼轴长为22.79mm。而年龄、性别、收缩压、舒张压、视网膜激光光凝治疗史、术前抗VEGF治疗史、术中全视网膜激光光凝点数、术后第1天眼压、术后第2天眼压、血肌酐、尿素氮与ERD的发生无相关性。结论:较低的血浆白蛋白浓度、较短的眼轴长、白内障手术史与增殖性糖尿病性视网膜病变经玻璃体切除术后发生渗出性视网膜脱离的发生有相关性。
[Abstract]:Objective: to study the factors associated with proliferative diabetic retinopathy induced exudative retinal detachment ERD after vitrectomy with pars plana vitrectomy. Methods: patients with proliferative diabetic retinopathy were selected from December 2015 to December 2015. In December 2016, he was admitted to the ophthalmology department of the ophthalmology center of the second Hospital of Jilin University. The exclusion criteria for PDR patients undergoing PPV surgery in our medical group were as follows: patients with systemic diseases other than diabetes mellitus and hypertension, patients with cataract removal, History of ophthalmic surgery other than intraocular lens implantation or total retinal laser photocoagulation; persons with a history of eye tumors, other retinal vascular diseases, uveitis, sclera, ocular trauma, congenital eye disease, etc. Results: during this period, A total of 160 eyes of 127 patients were enrolled in this study. There were 61 cases (76 eyes) with 47.5 eyes and 66 cases with 84 eyes (52.5 eyes) in which 17 eyes (10.63 eyes) showed exudative retinal detachment with different degrees of exudative choroidal detachment. The average age of all patients was 51.5 years old and 21-74 years old. The main factors related to the analysis were age, sex, diastolic blood pressure, systolic blood pressure, plasma albumin concentration, retinal laser photocoagulation points during operation, and eye axis length. Have you ever had cataract extraction, intraocular lens implantation, retinal laser photocoagulation, anti- VEGF treatment before operation, intraocular pressure on the first day after surgery, intraocular pressure on the second day after surgery, and serum creatinine? Urea nitrogen. After univariate analysis, the possible factors associated with the occurrence of ERD were as follows: plasma albumin concentration (P0. 017, P < 0. 023), history of cataract surgery, history of anti VEGF treatment before operation (P 0. 012). The above four factors were found by binary logistic analysis. The factors associated with the occurrence of ERD were as follows: plasma albumin concentration (P0. 017), axial length (P0. 013), history of cataract surgery (P0. 032). The mean plasma albumin concentration of patients with ERD in this group was 38. 88 g / L, and the average axial length was 22. 79 mm. age, sex, systolic blood pressure, Diastolic blood pressure, history of retinal laser photocoagulation, history of preoperative anti-#en0# therapy, intraoperative total retinal laser photocoagulation points, intraocular pressure on the first day after operation, intraocular pressure on the second day after operation, serum creatinine, There was no correlation between urea nitrogen and ERD. Conclusion: lower plasma albumin concentration, shorter eye axis length, The history of cataract surgery is associated with exudative retinal detachment after vitrectomy for proliferative diabetic retinopathy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R779.6

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