Risk factor analysis of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Gao Shaohui , Pei Han ,  Zhao Zhaoxia , Meng Zijun , Jin Xuemin

Henan Provincial People's Hospital, Henan Eye Hospital & Henan Eye Institute, School of Clinical Medicine, Henan University, Zhengzhou 450003, China;

Corresponding author：

Zhao Zhaoxia, Email: zhaozhaoxia61@126.com

Keywords：

Diabetic retinopathy/surgery; Vitreous hemorrhage/etiology; Vitrectomy/adverse effects

DOI：

10.3760/cma.j.issn.1005-1015.2019.02.006

Video：

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Objective To investigate the risk factors of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy (PDR).Methods From June 2015 to June 2017, 103 eyes of 103 patients with PDR diagnosed and underwent minimalvitrectomy in Henan Provincial People's Hospital were enrolled in the study. There were 58 males and 45 females, with the average age of 58.37±10.14 years and diabetes duration of 8.7±7.2 years. Baseline systemic parameters including sex, age, diabetes duration, hypertension, HbA1c, creatinine, whether received anticoagulants, ocular parameters including whether combined with vitreous hemorrhage, whether finished panretinal photocoagulation (PRP), whether received treatment of anti-VEGF, whether combined with iris neovascularization (NVI), lens status preoperatively, whether hypotony postoperatively and intraoperative parameters including whether disc neovascularization (NVD) bleeding, whether fibrovascular membrane (FVM) residual, laser points, whether combined with cataract phacoemulsification were identified by multivariate logistic regression analysis.Results Twenty-nine of 103 eyes (28.15%) developed PVH in 1 day to 6 months after surgery, with self absorption of 18 eyes and reoperation of 11 eyes. Univariate analysis showed there were significant differences in age (t=2.124, P=0.036), anti-VEGF(χ²=7.105, P=0.008), NVD bleeding (χ²=10.158, P=0.001) and FVM residual(χ²=8.445, P=0.004) between patients with and without postoperative vitreous hemorrhage. Sex (χ²=0.021, P=0.884), diabetes duration (t=0.87, P=0.386), hypertension (χ²=2.004, P=0.157), HbA1c (t=1.211, P=0.229), creatinine (t=0.851, P=0.397), preoperative oral anticoagulants (χ²=0.985, P=0.321), preoperative vitreous hemorrhage (χ²=0.369, P=0.544), PRP (χ²=1.122, P=0.727), NVI (χ²=2.635, P=0.105), lens status (χ²=0.172, P=0.679), hypotony postoperatively (χ²=1.503, P=0.220), laser points (χ²=1.391, P=0.238) and combined phacoemulsification surgery (χ²=0.458, P=0.499) were not associated with PVH. Multivariate logistic regression analysis revealed the more PVH appeared in younger (OR=1.065, P=0.009) and NVD bleeding (OR=6.048, P=0.001) patients.Conclusion Younger age and NVD bleeding are the important risk factors for PVH after minimal vitrectomy without endotamponade in PDR.

Citation： Gao Shaohui, Pei Han, Zhao Zhaoxia, Meng Zijun, Jin Xuemin. Risk factor analysis of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2019, 35(2): 135-139. doi: 10.3760/cma.j.issn.1005-1015.2019.02.006 Copy

1.	Cruz-Iñigo YJ, Acabá LA, Berrocal MH. Surgical management of retinal diseases: proliferative diabetic retinopathy and traction retinal detachment[J]. Dev Ophthalmol, 2014, 54: 196-203. DOI: 10.1159/000360467.
2.	Comyn O, Wickham L, Charteris DG, et al. Ranibizumab pretreatment in diabetic vitrectomy: a pilot randomised controlled trial (the RaDiVit study)[J]. Eye (Lond), 2017, 31(9): 1253-1258. DOI: 10.1038/eye.2017.75.
3.	梁建宏, 黎晓新. 增生型糖尿病视网膜病变玻璃体切割手术中眼内填充物和抗血管内皮生长因子药物应用利弊[J]. 中华眼底病杂志, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.Liang JH, Li XX. Advantages and disadvantages of tamponade and anti-VEGF drugs applied in vitrectomy for proliferativediabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.
4.	Yau GL, Silva PS, Arrigg PG, et al. Postoperative Complications of pars plana vitrectomy for diabetic retinal disease[J]. Semin Ophthalmol, 2018, 33(1): 126-133. DOI: 10.1080/08820538.2017.1353832.
5.	Wilkinson CP, Ferris FL, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682. DOI: 10.1016/S0161-6420(03)00475-5.
6.	Park DH, Shin JP, Kim SY. Comparison of clinical outcomes between 23-gauge and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy[J]. Retina, 2010, 30(10): 1662-1670. DOI: 10.1097/IAE.0b013e3181d95261.
7.	Lee BJ, Yu HG. Vitreous hemorrhage after the 25-gauge transconjunctival sutureless vitrectomy for proliferative diabetic retinopathy[J]. Retina, 2010, 30(10): 1671-1677. DOI: 10.1097/IAE.0b013e3181dcfb79.
8.	Khuthaila MK, Hsu J, Chiang A, et al. Postoperative vitreous hemorrhage after diabetic 23-gauge pars plana vitrectomy[J]. Am J Ophthalmol, 2013, 155(4): 757-763. DOI: 10.1016/j.ajo.2012.11.004.
9.	Ahn J, Woo SJ, Chung H, et al. The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy[J]. Ophthalmology, 2011, 118(11): 2218-2226. DOI: 10.1016/j.ophtha.2011.03.036.
10.	高韶晖, 路小楠, 栗占荣, 等. 微创玻璃体切割手术联合改良脉络膜上腔引流治疗脉络膜脱离型视网膜脱离的疗效观察[J]. 中华眼底病杂志, 2018, 34(2): 116-119. DOI: 10.3760/cma.j.issn.1005-1015.2018.02.003.Gao SH, Lu XN, L ZR, et al. Clinical effect of minimally invasive vitreoretinal surgery combined with a modified suprachoroidal drainage surgery for retinal detachment associated with choroidal detachment[J]. Chin J Ocul Fundus Dis, 2018, 34(2): 116-119. DOI: 10.3760/cma.j.issn.1005-1015.2018.02.003.
11.	Balakrishnan D, Jain B, Nayaka A, et al. Role of tamponade in vitrectomy for proliferative diabetic retinopathy with vitreous hemorrhage[J]. Semin Ophthalmol, 2017, 32(4): 488-491. DOI: 10.3109/08820538.2015.1120757.
12.	Sato T, Tsuboi K, Nakashima H, et al. Characteristics of cases with postoperative vitreous hemorrhage after 25-gauge vitrectomy for repair of proliferative diabetic retinopathy[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(4): 665-671. DOI: 10.1007/s00417-016-3522-8.
13.	Shen YD, Yang CM. Extended silicone oil tamponade in primary vitrectomy for complex retinal detachment in proliferative diabetic retinopathy: a long-term follow-up study[J]. Eur J Ophthalmol, 2007, 17(6): 954-960. DOI: 10.1177/112067210701700614.
14.	Zhang G, Chen H, Chen W, et al. Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study[J]. Br J Ophthalmol, 2017, 101(12): 1591-1595. DOI: 10.1136/bjophthalmol-2017-310316.

1. Cruz-Iñigo YJ, Acabá LA, Berrocal MH. Surgical management of retinal diseases: proliferative diabetic retinopathy and traction retinal detachment[J]. Dev Ophthalmol, 2014, 54: 196-203. DOI: 10.1159/000360467.
2. Comyn O, Wickham L, Charteris DG, et al. Ranibizumab pretreatment in diabetic vitrectomy: a pilot randomised controlled trial (the RaDiVit study)[J]. Eye (Lond), 2017, 31(9): 1253-1258. DOI: 10.1038/eye.2017.75.
3. 梁建宏, 黎晓新. 增生型糖尿病视网膜病变玻璃体切割手术中眼内填充物和抗血管内皮生长因子药物应用利弊[J]. 中华眼底病杂志, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.Liang JH, Li XX. Advantages and disadvantages of tamponade and anti-VEGF drugs applied in vitrectomy for proliferativediabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.
4. Yau GL, Silva PS, Arrigg PG, et al. Postoperative Complications of pars plana vitrectomy for diabetic retinal disease[J]. Semin Ophthalmol, 2018, 33(1): 126-133. DOI: 10.1080/08820538.2017.1353832.
5. Wilkinson CP, Ferris FL, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682. DOI: 10.1016/S0161-6420(03)00475-5.
6. Park DH, Shin JP, Kim SY. Comparison of clinical outcomes between 23-gauge and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy[J]. Retina, 2010, 30(10): 1662-1670. DOI: 10.1097/IAE.0b013e3181d95261.
7. Lee BJ, Yu HG. Vitreous hemorrhage after the 25-gauge transconjunctival sutureless vitrectomy for proliferative diabetic retinopathy[J]. Retina, 2010, 30(10): 1671-1677. DOI: 10.1097/IAE.0b013e3181dcfb79.
8. Khuthaila MK, Hsu J, Chiang A, et al. Postoperative vitreous hemorrhage after diabetic 23-gauge pars plana vitrectomy[J]. Am J Ophthalmol, 2013, 155(4): 757-763. DOI: 10.1016/j.ajo.2012.11.004.
9. Ahn J, Woo SJ, Chung H, et al. The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy[J]. Ophthalmology, 2011, 118(11): 2218-2226. DOI: 10.1016/j.ophtha.2011.03.036.
10. 高韶晖, 路小楠, 栗占荣, 等. 微创玻璃体切割手术联合改良脉络膜上腔引流治疗脉络膜脱离型视网膜脱离的疗效观察[J]. 中华眼底病杂志, 2018, 34(2): 116-119. DOI: 10.3760/cma.j.issn.1005-1015.2018.02.003.Gao SH, Lu XN, L ZR, et al. Clinical effect of minimally invasive vitreoretinal surgery combined with a modified suprachoroidal drainage surgery for retinal detachment associated with choroidal detachment[J]. Chin J Ocul Fundus Dis, 2018, 34(2): 116-119. DOI: 10.3760/cma.j.issn.1005-1015.2018.02.003.
11. Balakrishnan D, Jain B, Nayaka A, et al. Role of tamponade in vitrectomy for proliferative diabetic retinopathy with vitreous hemorrhage[J]. Semin Ophthalmol, 2017, 32(4): 488-491. DOI: 10.3109/08820538.2015.1120757.
12. Sato T, Tsuboi K, Nakashima H, et al. Characteristics of cases with postoperative vitreous hemorrhage after 25-gauge vitrectomy for repair of proliferative diabetic retinopathy[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(4): 665-671. DOI: 10.1007/s00417-016-3522-8.
13. Shen YD, Yang CM. Extended silicone oil tamponade in primary vitrectomy for complex retinal detachment in proliferative diabetic retinopathy: a long-term follow-up study[J]. Eur J Ophthalmol, 2007, 17(6): 954-960. DOI: 10.1177/112067210701700614.
14. Zhang G, Chen H, Chen W, et al. Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study[J]. Br J Ophthalmol, 2017, 101(12): 1591-1595. DOI: 10.1136/bjophthalmol-2017-310316.

Chinese Journal of Ocular Fundus Diseases

Risk factor analysis of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy

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