Clinical Observation On The Prognosis Of Diabetic Retinopathy Threated By Vitrectomy Combined With Diabetic Nephropathy

Object:1.To analyze the prognosis on diabetic retinopathy with diabetic nephropathy treated by vitrectomy and compare with diabetic retinopathy without diabetic nephropathy.2.To analyze the risk factors of diabetic retinopathy and diabetic nephropathy in patients with diabetes mellitus.Methods:The clinical data of 304 patients(353 eyes)with proliferative diabetic retinopathy treated by vitrectomy in our ophthalmology center were selected.According to the standard of diabetic retinopathy established by Chinese Ophthalmology Society in 1985,the clinical data were divided into stage IV 16 eyes,stage V 126 eyes,stage VI 211 eyes.According to urine micro-protein test results,all patients were divided into no diabetic nephropathy Group(NDN Group)and diabetic nephropathy Group(DN Group),of which NDN group had 128 eyes and DN Group had 225 eyes.Detailed medical history was collected for all patients.All patients were assigned to a comprehensive eye examination,including visual acuity,intraocular pressure,anterior eye section,ocular posterior section,etc.Examination of urine routine,glycosylated hemoglobin,renal function and other routine examinations in hospital were excuted.After the operation,regular outpatient follow-up patients were collected to collect the data of their eyesight improvement and postoperative complications to evaluate the prognosis.Non-parametric test,Chi-Square test,analysis of variance and Binary logistic regression were used with SPSS to analyze all the data.Result:1.In different stages of DR,the pdr of patients with phase IV,V and VI were increased gradually(P<0.05).2.The proportion of male patients in DN Group was higher than that of NDN group(P<0.01).3.The prevalence rate of hypertension in DN Group was higher than that in NDN group(P<0.01),and the patients with coronary heart disease and cerebral infarction in DN group were higher than NDN group(P<0.05).4.The DN Group was higher in the comparison of the systolic blood pressure level and glycosylated hemoglobin level in different stages of DR(P<0.05).5.The proportion of postoperative vision improvement in DN Group was lower than that in NDN group(P<0.05),and the proportion of postoperative complication of DN Group was higher than that of NDN group(P<0.05).6.The risk factors of diabetic retinopathy and diabetic nephropathy in patients with diabetes mellitus are as follows: Type 1 diabetes mellitus,combined coronary heart disease,smoking history,high systolic blood pressure,long-term hyperglycemia.Conclusion:1.For PDR patients with vitrectomy,the associated DN were less visually impaired than those with no DN.2.For PDR patients with vitrectomy,the probability of postoperative bleeding and PVR increased after the combination of DN compared with those without DN.3.Type 1 diabetes mellitus,combined coronary heart disease,smoking history,high systolic pressure and long-term hyperglycemia are risk factors of diabetic retinopathy and diabetic nephropathy in patients with diabetes mellitus.