Analysis Of The Relationship Between Vitrectomy Opportunity And Clinical Curative Effect In Diabetic Vitreous Hemorrhage

Objective:To explore the opportunity of surgery and evaluate the effect of treatment by comparing visual acuity results of different stages of surgical treatment in diabetic vitreous hemorrhage.Methods:We made a retrospective analysis to 602 patients (785 eyes) diagnosed in our hospital due to diabetic retinopathy with vitreous hemorrhage (stage IV-V PDR) and received vitrectomy from Mar.2005 to Jun.2009. Based on the time from vitreous hemorrhage to surgery, the patients were divided into 1 month group,2 months group, 4 months group and more than 4 months group. The standard three-channel closed pars plana vitrectomy (PPV) was used. The proliferatiive or thickening retina and that merged partial retinal detachment had been treated by vitrectomy combined with silicone oil tamponade, the rest with gas(C2F6) tamponade, and some patients only with simple PPV without oil or gas. These patients were followed up for 6 months to 36 months, with an average follow-up 21 months and were observed postoperative best corrected visual acuity and surgical complications. The statistical analysis used X2 test.Results:After followed up for 6 months to 36 months,1 month group(143eyes), of which 140 eyes have got different degrees of visual improvement, the visual acuity of 48 eyes was above 0.3(33.6%), the best corrected visual acuity(BCVA) reached above 0.8, average visual acuity was 0.3±0.227, complications occurred in 6 eyes (2.7%) (2.7%); 2 months group (210 eyes) with visual acuity of 0.1 in 207 eyes (98.6%), of which more than 0.3 was in 51 eyes (24.3%), BCVA was 0.7, the average visual acuity 0.3±0.130, complications in 31 eyes (14%); and 4 months group (195 eyes) with only 171 eyes visual acuity improved, of which above 0.3 was in 40 eyes (20.5%), BCVA of 0.5, the average visual acuity 0.28±0.181, complications in 49 eyes (22.2%); but in the group of more than 4 months(237 eyes), the visual acuity of 32 eyes was more than 0.3 (13.5%), BCVA of 0.4, and two eyes were eventually blind, the average visual acuity 0.25±0.160, complications took place in 135 eyes (61.1%). Compared 1 month group with 4 months groups or more than 4 months, the difference was statistically significant(P<0.05); but compared 1 month group with 2, the difference was no statistically significant(P>0.05). The postoperative visual acuity of 1 month group was significantly better than 4 months group and more than 4 months group, and complications less than 4 months group or the group of more than 4 months.Conclusion:Caused by diabetic retinopathy with vitreous hemorrhage, best postoperative corrected visual acuity following the time from vitreous hemorrhage to surgery showed a declining trend, a rise of complications. Therefore, only through correctly grasping diabetic vitreous surgery timing, and simultaneously, enough effective retinal photocoagulation was used in vitrectomy, can we improve the curative effect and reduce complications, and thereby reducing the blindness rate of diabetic eye disease.