| With the improvement of China's economic level and national material level,the prevalence of diabetes has increased significantly.According to the statistics of the international diabetes federation(IDF),there were about 382 million diabetics worldwide in 2013,and the number of diabetics in China reached 1/4 of the global population,about 98 million.DR is one of the most severe complication of diabetes mellitus and a leading cause of blindness.DR can further be divided into NPDR and PDR.NPDR causes central vision loss when it induces DME.PDR is the most advanced stage of DR,which is characterized by retinal neovasculization.The pathology of PDR includes vitreous hemorrhage,formation of fibrous peri-retinal tissue comprising neovascular blood vessels,tractional retinal detachment and total vision loss as the final stage.Various mechanisms play a role in the pathogenesis of DR,including the disruption of bloodretinal barrier,alterations to capillary vessel walls,synthesis of growth factors and nitric oxide,disruption of connective tissue by matrix metalloproteinases,and activation of various immune mechanisms.A meta-analysis of epidemiology in China showed that the incidence rates of DR,NPDR and PDR in patients with diabetes were 23.0%,19.1%and 2.8%,respectively[1].Vitreous hemorrhage is one of the common complications of DR.The incidence of vitreous hemorrhage is up to 7/100000[2],and PDR is the leading cause of non-traumatic vitreous hemorrhage.According to relevant studies at home and abroad,the incidence of PDR has reached 26.25%to 55.56%[3-6].Vitreous hemorrhage can not only make vitreous opacity,affect the light in the retina,causing patients vision fell sharply,but it can also cause tractional retinal detachment and hyperplastic vitreous retinopathy complications[7]Vitrectomy is the main clinical treatment of vitreous hemorrhage associated with PDR treatment,can help remove cloudy vitreous body,retina reset and intraoperative complete retinal photocoagulation,to help patients restore vision.However,most patients with PDR are more difficult,and the operation is more difficult,and it is more likely to have some serious complications after vitrectomy than other causes,such as vitreous hemorrhage again,neovascular glaucoma,retinal detachment and macular edema,causing serious burden to patients body and mind.This topic for the prospective study,the research objective:1.The study of single notoginseng with vitrectomy patients group(notoginseng group)and pure line vitrectomy(control group)in patients with preoperative,intraoperative and postoperative clinical curative effect difference between 2.Test between the two groups of patients with vascular endothelial growth factor in the vitreous and fibronectin concentration difference.Methods:29 eyes(both type 2 DM)were collected in the ophthalmic diagnosis of vitreous hemorrhage(PDR)in our hospital from January 2016 to September 2017.Men and women were randomly divided into three groups and a control group at the first time.Notoginseng of 14 cases(14 eyes)while the control group of 15 cases(15 eyes),control group except not notoginseng treated other treatment and follow-up with notoginseng group,observation records to compare between the two groups of patients with preoperative,intraoperative and postoperative clinical curative effect difference,and in patients with intraoperative collection vitreous concentrate(liquid nitrogen to-80 ? refrigerator),and postoperative follow-up of 3 months.Results:(1)the preoperative vitreous hemorrhage showed effect 2 eyes,effective 5 eyes,ineffective 7 eyes,hematocrit absorption improved 7 eyes,total effective rate 50.0%.In the control group,the vitreous hemorrhage in the preoperative period was effect 0 eyes,2 eyes were effective,13 eyes were ineffective,and 2 eyes were improved by hematopoiesis,and the total effective rate was 13.3%.Two groups of patients with preoperative vitreous hemorrhage absorption statistically difference(X2 =4.549,P=0.033).(2)after 2 weeks of preoperative intervention in the two groups,the visual acuity of the group was 4 eyes,and the control group had 0 eyes,and the best corrected visual difference was statistically significant(Z=-2.638,P=0.008).(3)the operation time was 23.13,±7.84min,and the control group was 28.74±4.29min,and the difference between the two groups was statistically significant(t=2.415,P=0.023).(4)during intraoperative hemorrhage,there were fewer new blood vessels in the retinal surface in the control group than in the control group,and the retinal edema was lighter,no obvious bleeding was seen in the operation,and the bleeding rate was 0%.In the control group,the retinal edema and exudation were more severe than those of the other three groups,and there were three cases of intraocular hemorrhage,and the bleeding rate was 20%,and the electrocoagulation was given.(5)Postoperative complications,there were 1 case of traction retinal detachment in the three or seven groups,and the incidence rate was 7%(1/14).In the control group,complications occurred in 5 cases,with a rate of 33%(5/15).(6)BCVA(3 days,2w,1 month,and 3 months)there was no statistically significant difference between the two groups of patients with BCVA in the two groups after surgery(Z=-0.0235 P=0,982).There was statistically significant difference between the two groups of patients after 2 weeks after surgery(Z=-1.987,P=0.047).The best corrected visual difference between the two groups was statistically significant(Z=-2.389,P=0.017).The best corrected visual difference between the two groups was statistically significant(Z=-2.123,P=0.034).(7)after preoperative and postoperative visual acuity of the two groups,the overall visual acuity of the patients was improved,but the visual acuity of the group was 9 eyes(64%),and the control group was improved by 5 eyes(33%).(8)intraocular pressure in the control group was 19.13 ± 2.75mmHg,and the intraocular pressure was 16.14±4.06mmHg,and the differences in the intraocular pressure were statistically significant(t=2.338,P=0.027).(9)differences in the concentration of VEGF and FN in vitreous bodies between the two groups.The VEGF concentration in the control group was 224.91±41.10pg/ml,and the VEGF concentration in the control group was 807.64±98.20pg/ml,and the VEGF concentration in the two groups was statistically significant(Z=-4.583,P=0.000).The FN concentration of the vitreous body of the group was 3.88±0.19ug/ml,and the FN concentration in the control group was4.29±0.25ug/ml± and the FN concentration of the vitreous body of the two groups was statistically significant(t=4.998,P=0.000).Research conclusions:1.The single notoginseng joint vitrectomy in the treatment of PDR patients with vitreous hemorrhage,compared with the simple lines of vitrectomy,can effectively promote the preoperative PDR patients with vitreous hemorrhage absorption,promote the patients with preoperative visual acuity,conducive to shorten the operation time,reduce intraoperative bleeding PDR patients,improve patients' postoperative visual acuity,reduce the postoperative complications,reduce the PDR patients postoperative incidence of high intraocular pressure.2.The expression of VEGF and FN in vitreous body of patients with PDR was suppressed. |
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