| Objective:This study investigated the risk factors for persistent corneal epithelial defects(PCED)after pars planavitrectomy(PPV)in patients with proliferative diabetic retinopathy(PDR).Methods:This was a retrospective,case control study.The charts of 201 consecutive PDR patients(201 eyes)who received PPV were reviewed.Among them,86 patients(86eyes)were male,and 115 patients(115 eyes)were female.There were 93 right eyes,and 108 left eyes studied.The age range was 30–81 years,the average age was 57.94±9.65 years;159 patients were?50 years of age,and 42 patients were<50 years of age.Diabetes duration was 3-30 years,the average age was13.87±6.023 years;There were 97patients had history of surgery,including cataract surgery,intravitreal drug injection and retinal laser photocoagulation.Patients's glycated hemoglobin(HbA1c)were<7.0%,and165 patients's HbA1c were?7.0%.The preoperative corneal endothelial cell density was 2493.89±610.31.36/mm~2.The diabetic retinopathy stages were as follows:stage?,24 eyes;stage?,78 eyes;and stage?,99 eyes.Among the 201 eyes,25 eyes underwent intraoperative epithelial debridement during surgery,71 eyes were combined with cataract surgery involving phacoemulsification,a laser photocoagulation count<1,000points was performed in 78 eyes,and?1,000 points were performed in 123 eyes.In total,61 eyes involved intravitreal silicone oil tamponade,18 eyes involved intravitreal tamponade with C3F8,and 122 eyes were not involved with intraocular tamponade.The time of surgery was 56 minutes-240minutes,and the average time of surgery was130.45±36.719 minutes.Postoperative persistent intraocular hypertension was defined as an intraocular pressure(IOP)that increased(non-contact intraocular pressure gauge?21mmHg)after PPV with necessary treatment using IOP-lowering medications for?2 weeks.The diagnostic criteria for corneal epithelial defects were taken from the Expert Consensus on Clinical Diagnosis and Treatment of Corneal Epithelial Defect in China(2016).The corneal epithelial defect was diagnosed as PCED if it was treated with common methods such as a lacrimal substitute or corneal contact lens,but showed no improvement and no signs of healing for?2 weeks.The incidence of PCED after eye surgery was recorded and its related risk factors were analyzed.A multivariate logistic regression was used to analyze the risk factors for PCED,which were expressed as a ratio and a 95%confidence interval.Results:Among the 201 eyes,16 eyes presented with PCED after surgery with a prevalence of 7.96%,and 185 eyes with no PCED with a prevalence of 92.04%.A multivariate logi stic regression showed that intraoperative epithelial debridement(OR=13.239,95%C I 2.999~58.442,P=0.001),intraoperative treatment in combination with cataract surg ery(OR=7.448,95%CI 1.975~28.091,P=0.003),intravitreal tamponade with C3F8(OR=11.344,95%CI2.169~59.324,P=0.004),and postoperative persistent intrao cular hypertension(OR=10.462,95%CI 2.464~44.414,P=0.001)were risk factor s for PCED after PPV.Conclusion:Persistent corneal epithelial defect after pars planavitrectomy in patients with pro liferative diabetic retinopathy is 7.96%,Intraoperative epithelial debridement,intraope rative treatment in combination with cataract surgery,intravitreal tamponade with C3F8,and postoperative persistent intraocular hypertension were risk factors for PCED in p atients with PDR after PPV. |
PDF Full Text Request