The Royal College of Ophthalmologists' National Ophthalmology Database Study of Vitreoretinal Surgery Report 6, Diabetic Vitrectomy
The Royal College of Ophthalmologists' National Ophthalmology Database Study of Vitreoretinal Surgery Report 6, Diabetic Vitrectomy
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DOI：
10.1001/jamaophthalmol.2015.4587
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发表时间：
2016-01-01
影响因子：
8.1
通讯作者：
Steel, David H. W.
中科院分区：
文献类型：
--
作者：
Jackson, Timothy L.;Johnston, Robert L.;Steel, David H. W.
重要性：患者和临床医生需要准确评估增殖性糖尿病视网膜病变的玻璃体切割手术的风险和益处，但临床试验数据可能不能反映现实世界的经验。目的对玻璃体切除术治疗增殖性糖尿病视网膜病变的并发症进行前瞻性审计，帮助建立基准。英国皇家眼科学院国家眼科数据库对英国16个不同的玻璃体视网膜单位因增殖性糖尿病视网膜病变接受初级玻璃体切除术的834例患者的939只眼睛进行了研究。数据为2001年1月至2010年11月。干预措施：伴有或不伴有分层/分割的玻璃体切除术。主要结局和测量：主要手术的描述、术中并发症的发生率和接受进一步手术的眼睛比例。对视力结果进行了探索性分析，术后6至12个月，视力成功和视力丧失分别定义为增加或减少0.3 logMAR或更多（约2个Snellen线）。结果：420只眼（408例患者）行玻璃体切除术，无分层，术中并发症发生率为13.1% (95% CI, 10.2%-16.7%[55 / 420眼])，126只眼（30.0%）需要玻璃体内填塞，49只眼（11.7%）进一步行玻璃体切除术（中位随访时间为6.9个月）；127只晶状眼一年内发生白内障的占17.9%，视力成功的占63.6%，视力下降的占8.2%。519只眼（463例患者中）行玻璃体切除术合并分层，术中并发症发生率为30.4%(95% CI, 26.6%-34.5%[519只眼中的158只])，299只眼（57.6%）需要玻璃体内填塞，78只眼（15.0%）进一步行玻璃体切除术（中位随访7.1个月）；126只晶状眼一年内发生白内障的占21.2%，视力恢复的占62.8%，视力丧失的占14.9%。结论和相关性糖尿病性玻璃体切除术有明显的并发症发生率，特别是如果需要分层或分割。尽管如此，现有的视力数据表明，大多数患者在视力方面取得了临床意义上的改善。
IMPORTANCE Patients and clinicians need to accurately assess the risks and benefits of pars plana vitrectomy for proliferative diabetic retinopathy, but clinical trial data may not reflect real-world experience.OBJECTIVE To prospectively audit the complications of vitrectomy for proliferative diabetic retinopathy and help establish benchmarks.DESIGN, SETTING, AND PARTICIPANTS Royal College of Ophthalmologists' National Ophthalmology Database study of 939 eyes of 834 patients undergoing primary vitrectomy for proliferative diabetic retinopathy at 16 different vitreoretinal units in the United Kingdom. Data were obtained for the period from January 2001 to November 2010.INTERVENTIONS Pars plana vitrectomy with or without delamination/segmentation. MAIN OUTCOMES AND MEASURES Descriptions of the primary procedures performed, intraoperative complication rate, and proportion of eyes undergoing further surgery. An exploratory analysis of visual outcome was undertaken, with visual success and visual loss defined as a gain or reduction of 0.3 logMAR or more, respectively (approximately 2 Snellen lines), 6 to 12 months after surgery.RESULTS Of 420 eyes (among 408 patients) that underwent vitrectomy without delamination, the intraoperative complication rate was 13.1% (95% CI, 10.2%-16.7%[55 of 420 eyes]), with 126 eyes (30.0%) requiring an intravitreal tamponade and 49 eyes (11.7%) undergoing further vitrectomy (median follow-up, 6.9 months); 17.9% of 127 phakic eyes developed cataracts within a year, with 63.6% achieving visual success and 8.2% visual loss. Of 519 eyes (among 463 patients) that underwent vitrectomy with delamination, the intraoperative complication rate was 30.4%(95% CI, 26.6%-34.5%[158 of 519 eyes]), with 299 eyes (57.6%) requiring an intravitreal tamponade and 78 eyes (15.0%) undergoing further vitrectomy (median follow-up, 7.1 months); 21.2% of 126 phakic eyes developed cataracts within a year, with 62.8% achieving visual success and 14.9% visual loss.CONCLUSIONS AND RELEVANCE Diabetic vitrectomy has an appreciable complication rate, particularly if delamination or segmentation are required. Nonetheless, the data available on visual acuity suggest that a majority of patients achieve clinically meaningful gains in vision.