Analysis of related risk factors of vitreous hemorrhage after anti-vascular endothelial growth factor combined with vitrectomy for proliferative diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Feng Yanbing ¹ , Zhu Chenting ² , He Yanyan ¹ , Zhu Yongwei ¹ , Jiang Lijun ¹ , Luo Weiling ¹ , Wu Yibo ³ ,  Weng Wenqing ¹

1. Department of Ophthalmology, Zhejiang Chinese Medical University Affiliated Jiaxing TCM Hospital, Jiaxing Eye Hospital, Jiaxing 314000, China;
2. Department of Ophthalmology, Jiaxing Second Hospital of Zhejiang Province, Jiaxing 314000, China;
3. The Third Clinical Medical College of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310053, China;

Corresponding author：

Weng Wenqing, Email: wengwenq@163.com

Keywords：

Vitreous hemorrhage; Diabetic retinopathy; Vitrectomy; Angiogenesis inhibitors/therapeutic use; Root cause analysis

DOI：

10.3760/cma.j.issn.1005-1015.2020.02.003

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Objective To observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).Methods Retrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data.Results Of the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH (χ²=5.741, 8.103; P＜0.05). There was no significant difference in age (t=－1.364), duration of diabetes (t=0.538), preoperative vision (t=1.897), preoperative fasting blood glucose level (t=1.938), preoperative postprandial blood glucose level (t=1.508), preoperative systolic blood pressure (t=－0.571), preoperative diastolic blood pressure (t=0.275), whether received laser treatment (χ²=2.678), the number of laser points during operation (t=0.565), whether received lens removal during operation (χ²=0.331), whether found new blood vessels during operation (χ²=2.741) and whether received intraocular filling during operation (χ²=0.060) between the patients with and without PVH (P＞0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH (r_s=0.208, 0.229, 0.240, 0.285; P＜0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery (OR=5.175, 13.915; P＜0.05).Conclusion Fundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV.

Citation： Feng Yanbing, Zhu Chenting, He Yanyan, Zhu Yongwei, Jiang Lijun, Luo Weiling, Wu Yibo, Weng Wenqing. Analysis of related risk factors of vitreous hemorrhage after anti-vascular endothelial growth factor combined with vitrectomy for proliferative diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2020, 36(2): 99-104. doi: 10.3760/cma.j.issn.1005-1015.2020.02.003 Copy

1.	Yang X, Xu J, Wang R, et al. A randomized controlled trial of conbercept pretreatment before vitrectomy in proliferative diabetic retinopathy[J/OL]. J Ophthalmol, 2016, 2016(9): 1-8[2016-02-10]. https://www.researchgate.net/publication/298209026_A_Randomized_Controlled_Trial_of_Conbercept_Pretreatment_before_Vitrectomy_in_Proliferative_Diabetic_Retinopathy. DOI: 10.1155/2016/2473234.
2.	楚艳华, 刘玉燕, 王莹, 等. 增生型糖尿病视网膜病变患眼玻璃体切割手术后玻璃体再积血原因及预后观察分析[J]. 中华眼底病杂志, 2017, 33(4): 391-395. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.015.Chu YH, Liu YY, Wang Y, et al. The causes and prognosis of postoperative vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 391-395. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.015.
3.	Manabe A, Shimada H, Hattori T, et al. Randomized controlled study of intravitreal bevacizumab 0.16 mg injected one day before surgery for proliferative diabetic retinopathy[J]. Retina, 2015, 35(9): 1800-1807. DOI: 10.1097/IAE.0000000000000577.
4.	Wakabayashi, Usui Y, Tsubota K, et al. Persistent overproduction of intraocular vascular endothelial growth factor as a cause of late vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy[J]. Retina, 2017, 37(12): 2317-2325. DOI: 10.1097/IAE.0000000000001490.
5.	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.
6.	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.
7.	中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cam.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Clinical practice guidelines of diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cam.j.issn.0412-4081.2014.11.014.
8.	di Lauro R, De Ruggiero P, di Lauro R, et al. Intravitreal bevacizumab for surgical treatment of severe proliferative diabetic retinopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2010, 248(6): 785-791. DOI: 10.1007/s00417-010-1303-3.
9.	Hattori T, Shimada H, Nakashizuka H, et a1. Dose of intravitreal bevacizumab (Avastin) used as preoperative adiunct therapy for proliferative diabetic retinopathy[J]. Retina, 2010, 30(5): 761-764. DOI: 10.1097/IAE.0b013e3181c70168.
10.	Osaadon P, Fagan XJ, Lifshitz T, et a1. A review of anti-VEGF agents for proliferative diabetic retinopathy[J]. Eye, 2014, 28(5): 510-520. DOI: 10.1038/eye.2014.13.
11.	Yeh PT, Yang CM, Yang CH, et al. Cryotherapy of the anterior retina and sclerotomy sites in diabetic vitrectomy to prevent recurrent vitreous hemorrhage: an ultrasound biomicroscopy study[J]. Ophthalmology, 2005, 112(12): 2095-2102. DOI: 10.1016/j.ophtha.2005.07.010.
12.	Bressler NM, Beaulieu WT, Bressler SB, et al. Anti-vascular endothelial growth factor therapy and risk of traction retinal detachment in eyes with proliferative diabetic retinopathy: pooled analysis of five DRCR retina network randomized clinical trials[J/OL]. Retina, 2019, 2019: E1[2019-09-17]. https://insights.ovid.com/crossref?an=00006982-900000000-96047. DOI: 10.1097/IAE.0000000000002633.[published online ahead of print].
13.	Russo A, Longo A, Avitabile T, et al. Incidence and risk factors for tractional macular detachment after anti-vascular endothelial growth factor agent pretreatment before vitrectomy for complicated proliferative diabetic retinopathy[J/OL]. J Clin Med, 2019, 8(11): 1960[2019-11-13]. https://www.researchgate.net/publication/337265539_Incidence_and_Risk_Factors_for_Tractional_Macular_Detachment_after_Anti-Vascular_Endothelial_Growth_Factor_Agent_Pretreatment_before_Vitrectomy_for_Complicated_Proliferative_Diabetic_Retinopathy. DOI: 10.3390/jcm8111960.
14.	Tapp RJ, Shaw JE, Harper CA, et al. The prevalence of and factors associated with diabetic retinopathy in the Australian population[J]. Diabetes Care, 2003, 26(6): 1731-1737. DOI: 10.2337/diacare.26.6.1731.

1. Yang X, Xu J, Wang R, et al. A randomized controlled trial of conbercept pretreatment before vitrectomy in proliferative diabetic retinopathy[J/OL]. J Ophthalmol, 2016, 2016(9): 1-8[2016-02-10]. https://www.researchgate.net/publication/298209026_A_Randomized_Controlled_Trial_of_Conbercept_Pretreatment_before_Vitrectomy_in_Proliferative_Diabetic_Retinopathy. DOI: 10.1155/2016/2473234.
2. 楚艳华, 刘玉燕, 王莹, 等. 增生型糖尿病视网膜病变患眼玻璃体切割手术后玻璃体再积血原因及预后观察分析[J]. 中华眼底病杂志, 2017, 33(4): 391-395. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.015.Chu YH, Liu YY, Wang Y, et al. The causes and prognosis of postoperative vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 391-395. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.015.
3. Manabe A, Shimada H, Hattori T, et al. Randomized controlled study of intravitreal bevacizumab 0.16 mg injected one day before surgery for proliferative diabetic retinopathy[J]. Retina, 2015, 35(9): 1800-1807. DOI: 10.1097/IAE.0000000000000577.
4. Wakabayashi, Usui Y, Tsubota K, et al. Persistent overproduction of intraocular vascular endothelial growth factor as a cause of late vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy[J]. Retina, 2017, 37(12): 2317-2325. DOI: 10.1097/IAE.0000000000001490.
5. 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.
6. 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.
7. 中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cam.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Clinical practice guidelines of diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cam.j.issn.0412-4081.2014.11.014.
8. di Lauro R, De Ruggiero P, di Lauro R, et al. Intravitreal bevacizumab for surgical treatment of severe proliferative diabetic retinopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2010, 248(6): 785-791. DOI: 10.1007/s00417-010-1303-3.
9. Hattori T, Shimada H, Nakashizuka H, et a1. Dose of intravitreal bevacizumab (Avastin) used as preoperative adiunct therapy for proliferative diabetic retinopathy[J]. Retina, 2010, 30(5): 761-764. DOI: 10.1097/IAE.0b013e3181c70168.
10. Osaadon P, Fagan XJ, Lifshitz T, et a1. A review of anti-VEGF agents for proliferative diabetic retinopathy[J]. Eye, 2014, 28(5): 510-520. DOI: 10.1038/eye.2014.13.
11. Yeh PT, Yang CM, Yang CH, et al. Cryotherapy of the anterior retina and sclerotomy sites in diabetic vitrectomy to prevent recurrent vitreous hemorrhage: an ultrasound biomicroscopy study[J]. Ophthalmology, 2005, 112(12): 2095-2102. DOI: 10.1016/j.ophtha.2005.07.010.
12. Bressler NM, Beaulieu WT, Bressler SB, et al. Anti-vascular endothelial growth factor therapy and risk of traction retinal detachment in eyes with proliferative diabetic retinopathy: pooled analysis of five DRCR retina network randomized clinical trials[J/OL]. Retina, 2019, 2019: E1[2019-09-17]. https://insights.ovid.com/crossref?an=00006982-900000000-96047. DOI: 10.1097/IAE.0000000000002633.[published online ahead of print].
13. Russo A, Longo A, Avitabile T, et al. Incidence and risk factors for tractional macular detachment after anti-vascular endothelial growth factor agent pretreatment before vitrectomy for complicated proliferative diabetic retinopathy[J/OL]. J Clin Med, 2019, 8(11): 1960[2019-11-13]. https://www.researchgate.net/publication/337265539_Incidence_and_Risk_Factors_for_Tractional_Macular_Detachment_after_Anti-Vascular_Endothelial_Growth_Factor_Agent_Pretreatment_before_Vitrectomy_for_Complicated_Proliferative_Diabetic_Retinopathy. DOI: 10.3390/jcm8111960.
14. Tapp RJ, Shaw JE, Harper CA, et al. The prevalence of and factors associated with diabetic retinopathy in the Australian population[J]. Diabetes Care, 2003, 26(6): 1731-1737. DOI: 10.2337/diacare.26.6.1731.

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Analysis of related risk factors of vitreous hemorrhage after anti-vascular endothelial growth factor combined with vitrectomy for proliferative diabetic retinopathy

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