Observation Of The Effects Of Ocular Surface Between Combined Surgery And Sequential Surgery In Treating Proliferative Diabetic Retinopathy

Purposes: This study observe the effects of ocular surface between combined surgery and sequential surgery in treating proliferative diabetic retinopathy,it provide a reference to choose which surgery.Method: The study population consisted of 78 patients(78 eyes)who underwent 23 Gauge Pars Plana Vitrectomy(PPV)for PDR from the Ophthalmic Center of Qingdao Municipal Hospital from June 2018 to December 2019.The patients were divided in to combined-surgery group(A group)and sequential-surgery group(B group).A group was performed on patients with obvious lens opacity which was an obstacle to the ocular fundus surgery,while B group was performed on the patients with transparent lens or lens with light opacity on which ocular fundus surgery could be performed.Lens excision in cataractopoiesis could only be performed when the state of ocular fundus was stable and cataractopoiesis was the main cause of vision damage.In A group,there were 47 patients(47 eyes),including 22 males(22 eyes)and 25 females(25 eyes),the age range was 44-72(average 57.02±7.46)years old,the diabetes duration range was 5-27(average 14.60±5.08)years,the preoperative and postoperative Hb A1 c range was 4.60-11.40(average7.81±1.59)% and 4.40-11.40(average 7.78±1.56)% respectively,the Sehirmer’s test(SIt)range was 10-2(average 14.62±3.35)mm,the retinal laser points range was 265-1557(average 991.09±329.11)points,the operation duration range was 40-120(average70.11±17.68)min.In B group,there were 31 patient(31 eyes),including 17 males(17eyes)and 14 females(14eyes),the age range was 44-70(average 57.10±6.44)years old,the diabetes duration range was 3-27(average 15.23±6.45)years,the preoperative and postoperative Hb A1 c range was 4.40-10.20(average 7.59±1.29)% and 4.60-10.20(average 7.49±1.24)% respectively,the Sehirmer’s test(SIt)range was 7-21(average13.87±4.32)mm,the retinal laser points range was 288-1876(average 938.77±394.57)points,the operation duration range was 40-95(average 67.26 ±17.07)min,the interval between two types of surgical treatment range was 2-16(average 7.52±3.99)months.This study was a retrospective case-control study.1.Corneal sensitivity(CS)and corneal nerve fiber length(CNFL)were measured before surgery,1month,3 months,and 6 months after surgery;2.The Ocular Surface Disease Index(OSDI)questionnaire,the non-invasive tear meniscus height(NITH),The non-invasive tear film break-up time(NIBUT),Lipid layer observation,and corneal fluorescence staining(CFS)were measured 6 months after surgery.Result: General situation: there was no significantly difference in general situation between the two groups(P > 0.05),such as,gender,age,the duratiom of DM,the preoperative and postoperative Hb A1 c level,S I t,the retinal laser points,the operation duration;Observational index: 1.Compared the postoperative with preoperative CS and CNFL in the A group and the B group,both have decreased,and the difference is statistically significant(all P<0.05);2.Compared with each time points of CS and CNFL after operation in the A group and the B group,at 1 month,3month after surgery,the B group was higher than the A group,and the difference was statistically significant(all P<0.05).There was no significant difference in CS and CNFL between the two groups at 6 months after surgery(P>0.05);3.At 6 month after surgery,compare A group with B group,there was no significantly difference in OSDI,NITMH,FTBUT,ATBUT,Lipid layer observation,CFS(all P<0.05);4.Compared the postoperative with normal standard OSDI,NITMH,NIBUT in the A group and the B group,the OSDI was higher than normal standard,the NITMH and NIBUT were lower than normal standard,and the difference is statistically significant(all P<0.05).Conclusion: 1.PPV can damage the corneal nerve of diabetic patients,reducing the CS and CNFL.It was observed that the comeal nerve did not return to the preoperative level at 6 months after surgery;2.The CNFL and CS at 1 month,3month after sequential surgery was higher than that of combined surgery,however,at 6 month after surgery,there was no difference in CS,CNFL,OSDI,NITMH,FTBUT,ATBUT,Lipid layer observation and CFS,compare A with B.