| Objective:To investigate the early changes of anterior chamber depth(ACD)and the influencing factors after vitrectomy(include phacovitrectomy)in patients with proliferative diabetic retinopathy(PDR).Methods:This study was a retrospective clinical study collected 93 patients(98 eyes)with PDR who received PPV(include phacovitrectomy)from September 2017 to December 2018 in Qingdao Municipal Hospital ophthalmic center.According to the different operation,the 98 eyes can be divided into vitrectomy surgery group(simple group)41 eyes,vitrectomy combined phacoemulsification with intraocular lens implantation group(combined group)57 eyes,and according to the different intravitreal tamponade,the simple group was divided into the silicone oil group 19 eyes and balanced salt solution group 22 eyes.At the same time,the combined group was also divided into silicone oil group 26 eyes and balanced salt solution group 31 eyes.IOL-Master was used to measure all patients' ACD at preoperative 1 d,postoperative 1 d,3 d,5 d,7 d,2 w,1 mon.Meanwhile,posterior synechia was also observed.All data was processed using SPSS 17.0,and p<0.05 indicated that the difference had statistically significant.Results:Among the 98 eyes,16 eyes presented with posterior synechia at postoperative 1mon with a prevalence of 16.33%(1 6/98).In simple group-balanced salt solution group,the ACD at preoperative 1 d,postoperative 1 d,3 d,5 d,7 d,2 w,1 mon were(3.22±0.18mm),(3.14±0.21mm),(3.09±0.21mm),(3.13±0.21mm),(3.18±0.19mm),(3.21±0.17mm),(3.24±0.18mm).In simple group-silicone oil group.the ACD at preoperative 1 d,postoperative 1 d,3 d,5 d,7 d,2 w,1 mon were(3.23±0.13mm),(3.09±0.13mm),(2.98±0.17mm),(3.05±0.16mm),(3.13±0.12mm),(3.19±0.12mm),(3.22±0.14mm).In combined group-balanced salt solution group.the ACD at preoperative 1 d,postoperative 1 d,3 d,5 d,7 d,2 w,1 mon were(3.23 ± 0.27mm),(4.50 ± 0.26mm),(4.35 ± 0.29mm),(4.45 ± 0.28mm),(4.48±0.29mm),(4.54 ± 0.27mm),(4.55±0.35mm).In combined group-silicone oil group,the ACD at preoperative 1d,postoperative 1 d,3 d,5 d,7 d,2 w,1 mon were(3.23Q0.20mm),(4.44±0.25mm),(4.24±0.33mm),(4.39±0.26mm),(4.46±0.24mm),(4.50±0.23mm).(4.52±0.22mm).The results of Mann-Whitney U test showed that there were more inflammatory cells in anterior chamber in the combined group than in the simple group at postoperative 1d,3d,5d(P<0.05).And there were more inflammatory cells in anterior chamber in the silicone oil group than in the balanced salt solution group at postoperative 3d,5d,7d(P<0.05).The results of two independent-samples T-test showed that the ACD at postoperative 3d compared with the ACD at postoperative 1d,the combined group had a significantly decrease than the simple group(P<0.05),and the silicone oil group had a significantly decrease than the balanced salt solution group(P<0.05);the ACD at postoperative 2w compared with the ACD at postoperative 1d,the simple group had a significantly increase than the combined group(P<0.05),and the silicone oil group had a significantly increase than the balanced salt solution group(P<0.05).Pearson correlation analysis results showed that the surgical method,intravitreal tamponade.HbA1c,DM duration,endolaser photocoagulation points.duration of surgery were independent correlates of the changes of ACD from postoperative 1d to postoperative 3d(P<0.05).Multivariate linear regression analysis was performed on the variables obtained by Pearson correlation analysis.The surgical method,intravitreal tamponade,HbA1c,endolaser photocoagulation points,duration of surgery were all affect the change of anterior chamber depth from postoperative 1d to postoperative 3d(P<0.05).Conclusion:1.In simple group,the overall trend of ACD in PDR patients was shallow at first and then gradually returned to the preoperative level,and the ACD reached the shallowest at postoperative 3d.2.The overall trend of ACD in PDR patients after combined surgery was first deepened,then decreased and finally gradually returned to the normal level,and the anterior chamber depth reached the shallowest at postoperative 3d.3.There were more inflammatory cells in anterior chamber in the combined group than in the simple group at postoperative 1d,3d,5d(P<0.05).And there were more inflammatory cells in anterior chamber in the silicone oil group than in the balanced salt solution group at postoperative 1 d,3d,5d(P<0.05).4.The ACD at postoperative 3d compared with the ACD at postoperative 1d,the combined group had a significantly decrease than the simple group(P<0.05),and the silicone oil group had a significantly decrease than the balanced salt solution group(P<0.05).5.The surgical method,intravitreal tamponade,HbA1c,endolaser photocoagulation points,duration of surgery of PDR patients were all affect the change of anterior.chamber depth from postoperative 1d to postoperative 3d(P<0.05).6.The incidence of posterior synechia in PDR patients at 1 month after PPV surgery was 16.33%(16/98). |
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