Clinical Analysis Of 25G + Minimally Invasive Vitrectomy For Proliferative Diabetic Retinopathy

Purpose:To explore the safety and effectiveness of 25G+ minimally invasive vitrectomy in the treatment of proliferative diabetic retinopathy(PDR);to explore the risk factors of visual improvement after PDR,and to explore the risk factors of postoperative complications.Methods:Data of patients with diabetic retinopathy who underwent 25G+ vitrectomy from March 2017 to December 2018 in our hospital were collected and analyzed retrospectively.Age,sex,eye,duration of diabetes,hypertension,creatinine,urea nitrogen,glycosylated hemoglobin(HAb1c),preoperative retinal photocoagulation(PRP),preoperative vitreous injection of anti-VEGF drugs,surgery time,intraocular tamponade,preoperative and postoperative vision acuity,postoperative complications and other data were recorded.The effects of different tamponade,preoperative pan-retinal photocoagulation and preoperative anti-VEGF on the best corrected visual acuity and postoperative complications were analyzed.To analyze the risk factors of complications with high incidence of high intraocular pressure,anterior chamber exudation,vitreous rebleed,retinal detachment and choroidal detachment.Results:A total of 100 eyes with proliferative diabetic retinopathy in 80 patients were included。Mean BCVA improved from logarithm minimum angle of resolution(logMAR)1.67 ±0.63 to 1.01 ±0.64(p < 0.05).The best corrected visual acuity at the final follow-up improved two or more lines in 65.0% of eyes,was stable in 21.0% of eyes,and decreased two or more lines in 14.0% of eyes.Successful reattachment of the retina was achieved in 98% of eyes after one surgery and 100% of eyes at the final follow-up.Higher urea nitrogen was an independent risk factor for Visual acuity decreased(P < 0.05).Postoperative complications included transient high intraocular pressure(22.0%),anterior chamber exudation(7.0%),hyphema(1.0%),vitreous hemorrhage(8.0%),choroidal detachment(9.0%)and retinal detachment(11.0%).Most of these complications occur within 1 week after operation,and they are quickly relieved after corresponding symptomatic treatment.In multivariate analysis,only anterior chamber exudation was an independent risk factor for high intraocular pressure.In this study,no significant factors were found for anterior chamber exudation,but the incidence of anterior chamber exudation increased with the prolongation of operation time,the increase of urea nitrogen and the preoperative intervention of anti-vascular endothelial growth factor.Both preoperative PRP and preoperative anti-vascular therapy had a significant tendency to reduce vitreous hemorrhage.In univariate analysis,PDR stage VI,creatinine higher,shorter operation time and air tamponade were all associated with postoperative retinal detachment,but only air tamponade was found to be an independent risk factor for postoperative retinal detachment(P < 0.05).Among the univariate factors,operation time and air tamponade were all related to choroidal detachment after operation.In multivariate analysis,only air tamponade was an independent risk factor for choroidal detachment after operation.Conclusions:1.25G+ minimally invasive vitrectomy for proliferative diabetic retinopathy is a safe and effective surgical method.2.Renal function damage may be a risk factor for visual acuity after surgery.3.Preoperative PRP and preoperative anti-VEGF intervention can reduce early vitreous rebleed after surgery.4.The incidence of early retinal detachment and choroidal detachment in eye with air tamponade was higher.