Rubeosis iridis after vitrectomy for proliferative diabetic retinopathy

目的探讨增殖型糖尿病视网膜病变(PDR)行玻璃体手术后,虹膜红变(INV)发生的危险因素. 方法对451例PDR(536眼)行玻璃体手术治疗后INV的发生进行多因素logistic回归分析. 结果 44眼(8.2%)发生INV,12眼(2.2%)出现新生血管性青光眼;以术后1个月到半年时间段内INV发生率最高(48.3%).Logistic回归分析显示术前即存在INV和一次术后视网膜是否复位这两个因素与PDR患者玻璃体手术后INV的发生相关(P<0.001);PDRⅣ、Ⅴ、Ⅵ期发生率比较接近(分别为8.5%,6.1%,9.0%);术前完成全视网膜光凝的患者发生术后INV的比例更低(6.2% vs 9.9%).晶体状态为保留自身晶体的患者INV发生率最低(6.8%),与人工晶状体植入后囊完整组(8.9%)相比,差异无统计学意义(P＝0.525). 结论术前合并INV和一次术后视网膜脱离是术后INV发生的主要危险因素.PDR严重程度与INV发生没有明显关系.Objective To analyse the risk factors of the postoperative iris neovascularization(INV) of proliferative diabetic retinopathy(PDR) patients treated by vitreoretinal surgeries.(Methods) The postoperative INV was analysed in 451 PDR patients(536 eyes) after vitretomy.Risk factors were studied using multivariate logistic regression analysis. Results INV developed in 44 eyes(8.2%) and neovascluar glaucoma(NVG) occurred in 12 eyes(2.2%).The INV occurred most often in the course from 1 month to half a year after surgery.Logistic regression analysis showed that significant risk factors were preexisted INV and postoperative retinal detachment after the first vitrectomy(P<0.001).The INV rates of different stage of PDR eyes were approximate in each other(Ⅳ:8.5%,Ⅴ:6.1%,Ⅵ:9.0%).In the eyes treated by panretinal coagulation(PRP) before surgery,the INV rate was lower(6.2% vs 9.9%).In the patients who retained themselves′ lens,the postoperative INV rate was lowest(6.8%),with no statistical difference compared with intraocular lens group(8.9%).Conclusion The preexisted INV and postoperative retinal detachment after the first vitrectomy are major risk factors for postoperative INV.It seems that there is no obvious correlation(between) the severe stage of PDR and postoperative INV occurrence.中国科学引文数据库(CSCD)05332-3341