Therapeutic Effect And Prognostic Factors Of Vitrectomy For Proliferative Diabetic Retinopathy In Patients With Chronic Renal Failure

Objective:To investigate the efficacy and analyze prognosis of pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)patients with chronic renal failure(CRF).Methods:Retrospective study.A total of 44 eyes of 30 patients with chronic renal failure who underwent vitrectomy for PDR in our department from January 2014 to February 2018 were enrolled.All patients underwent ocular examinations including best corrected visual acuity(BCVA),intraocular pressure(IOP),slit lamp examination of the anterior segment,and dilated fundus examination.Systemic evaluation including serum,hemoglobin,albumin,cholesterol,triglyceride,uric acid,urea,coagulation routine,fasting blood-glucose and 2-hour post-meal blood glucose were performed.The course of diabetes and hypertension,preoperative fundus laser,history of ocular surgery including intravitreal injection of vascular endothelial growth factor and systemic hemodialysis were recorded.Intraoperative procedures including cataract surgery,intravitreal tamponade(silicone oil or gas),time of operation were also recorded.All patients discontinued aspirin and warfarin and other antiplatelet drugs 1 week before surgery.Perioperative blood pressure was controlled?160/90 mmHg,fasting blood-glucose ? 10.0mmol/L,2-hour post-meal blood glucose ?14.0mmol/L and hemoglobin ?75g/L.Hemodialysis patients were heparin-free for 1 week before and after surgery.Mean follow-up time was 12 months.The primary outcome was BCVA,and the secondary outcome includes presence of postoperative vitreous hemorrhage,neovascular glaucoma.Visual acuity was performed using a standard logarithmic visual acuity chart and the results were converted to a minimum resolution angular logarithm(logMAR)visual acuity record.Results:Preoperative logMAR BCVA was 1.65±0.58,and the mean postoperative logMAR BCVA was 0.86±0.53,the difference was statistically significant(t=-0.837,P=0.000 < 0.01).The visual acuity was improved in 32 eyes(72.7%),no change in 5 eyes(11.3%),and decreased in 7 eyes(16%).The visual acuity of 16 eyes was <0.1,and the visual acuity of 28 eyes was ?0.1.There were significant differences in postoperative ocular complications,staging of diabetic retinopathy,number of operations,and operation duration(?2=7.442,4.714,Z=-3.356,t=-2.967,P = 0.006,0.03,0.001,0.008<0.05).Postoperative vitreous hemorrhage(PVH)occurred in 11 eyes(25%).Intraoperative silicone oil tamponade and history of hemodialysis was significantly related to the absent PVH(?2=6.832,5.400,P=0.009,0.020 < 0.05).Neovascular glaucoma(NVG)occurred in 4 eyes(9.1%).Compared with natural factors in patients without NVG,the factor of age was statistically different(t=2.904,P=0.006<0.05).Conclusion:Vitrectomy for PDR patients with chronic renal failure can effectively improve the visual acuity of patients with chronic renal failure and improve the quality of life of patients.Preoperative advanced staging of diabetic retinopathy and postoperative ocular complications are risk factors for post-operative low vision in patients.Perioperative regular dialysis,intraoperative silicone oil tamponade can reduce the incidence of PVH after vitrectomy in patients with renal failure.Age is an important risk factor for occurrence of NVG.