Therapeutic Effects Of Vitrectomy For Proliferative Diabetic Retinopathy

PURPOSE: To elucidate the complications and risk factors influencing the outcome ofpatients with proliferative diabetic retinopathy undergoing pars plana vitrectomy, and investigate atherapeutic method safely and effectively to improve surgery effectiveness.METHODS: The clinical and follow-up data of patients who underwent vitrectomyfor proliferative diabetic retinopathy during January2012to December2013were reviewed.Compared the postoperative visual function and intraocular pressure from the aspect of sex, age,disease course, combined with hypertension, laser photocoagulation preoperatively, complications,different endotamponades and recurrent vitreous hemorrhage.Results:1. Patients’visual acuity got improved significantly at postoperatively1week and at lastfollow-up with different degrees (p=0.012, p=0.000);2. Sex, age, different endotamponades appears no significant difference compared topreoperative period (p>0.05);3. Disease course of diabetes affects prognosis of vitrectomy obviously at postoperatively1week and at last follow-up, the longer the course of disease, the less the postoperative visualacuity got improved (p=0.014, p=0.003). The patients got better postoperative visual acuitywithout hypertension (p=0.01). Lasering photocoagulation preoperatively performed affectedprognosis of vitrectomy at postoperatively1week with significant difference (p=0.021), butappears no significant difference at last follow-up (p=0.749). Different complications with PDRaffect prognosis of vitrectomy obviously at last follow-up (p=0.001), the eyes of PDR combinedwith tractional retinal detachment tend to have poorer visual acuity compared with commonvitreous hemorrhage.4. The intraocular pressure at postoperatively1day was (20.99+8.78) mmHg，6eyes’intraocular pressure level was (6-10) mmHg,47eyes’ was (10-21) mmHg,25eyes’ was (21-30)mmHg,18eyes’ was≥30mmHg, there was no intraocular pressure≤6mmHg. There were5 eyes’ intraocular pressure still≥21mmHg even using anti-glaucoma drug. One eye’s intraocularpressure was≥30mmHg, we took some silicone oil away from his vitreous, then his intraocularpressure was lower. There was one patient’s intraocular pressure was lower after implantation ofahmed valve. The intraocular pressure increased most at postoperatively1day and there is asignificant difference in intraocular pressure at postoperatively1day,1week and at last follow-upcompared to preoperatively (p=0.000, p=0.000, p=0.013)。5. Different endotamponades appear significant difference in intraocular pressure atpostoperatively1day and1week compared to preoperative period (p=0.012, p=0.010), the eyeswith oil or gas tamponade show higher intraocular pressures, but different endotamponades appearno significant difference in intraocular pressure at last follow-up (p=0.059). Laseringphotocoagulation preoperatively appears no significant difference in intraocular pressure atpostoperatively1week (p>0.05), but shows significant difference at last follow-up(p=0.042).Different complications with PDR appear significant differences at postoperatively1day,1weekand last follow-up (p=0.02, p=0.01, p=0.001), the eyes of PDR combined with tractional retinaldetachment tend to have higher intraocular pressure compared with common vitreous hemorrhage.6.There were56eyes were in corneal edema level0,21eyes in level1,19eyes in level2,there was no eyes in level4or5. Five eyes of the patients have vitrectomy combined withphacoemulsification,4of them were in corneal edema level2, and the other was in corneal edemalevel1. The intraocular pressure at postoperatively1week of patients in level0was (13.02±3.12)mmHg, level1was (14.33±3.72) mmHg, level2was (18.52±7.27) mmHg. Different cornealedema levels appear significant difference in intraocular pressure at postoperatively1weekcompared to preoperative period (p=0.003).7. The postoperative anterior chamber reaction at postoperatively1week was mild. Therewere73eyes in level1and the average intraocular pressure was (8.32±1.01) mmHg. There were18eyes in level2and the average intraocular pressure was (14.75±2.89) mmHg. There were5eyes in level3and the average intraocular pressure was (27.22±6.67) mmHg. Differentpostoperative anterior chamber reaction appear significant difference in intraocular pressure atpostoperatively1week compared to preoperative period (p=0.000).8. The occurrence of recurrent vitreous hemorrhage was9.62%,4of which were filled withbalanced salt solution, and the other one was filled with silicone oil. CONCLUSION:1.The majority fo PDR eyes obtained better visual improvement and quality of life aftervitrectomy, vitrectomy is an effective and safe therapy.2. The longer the course of disease and with hypertension, the less the postoperative visualacuity got improved. Lasering photocoagulation preoperatively performed better prognosis ofvitrectomy.The eyes of PDR combined with tractional retinal detachment tend to have poorervisual acuity compared with common vitreous hemorrhage. Therefore, active follow-up andlasering photocoagulation or vitrectomy should be performed as soon as possible for patients withlong course of disease, hypertension or combined with tractional retinal detachment.3.The intraocular pressure increased significantly after surgery, and the intraocular pressureincreased most at postoperatively1day. High intraocular pressure is a known complication ofvitrectomy, and is affected by many factors. The risk factors includ oil or gas tamponade, laseringphotocoagulation preoperatively, combined with tractional retinal detachment and heavy anteriorchamber inflammation.4. The postoperative anterior chamber reaction at postoperatively1week was mild, and allpatients got well at last follow-up.5.Recurrent vitreous hemorrhage is also a known complication of vitrectomy. Therefore,close follow-up is essential for vitrectomy to avoid the postoperative complications.