雷珠单抗玻璃体注射与玻璃体切除术治疗增殖性糖尿病视网膜病变  

The effect of intravitreal ranibizumab combined with vitrectomy for proliferative diabetic retinopathy

作　　者：禹海[1] 李鹤一[1] 王颖[1] 高明宏[1] 

机构地区：[1]沈阳军区总医院眼科,辽宁110015

出　　处：《中国实用眼科杂志》2014年第11期1301-1305,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 对比观察玻璃体切除术（pars plana vitrectomy,PPV）联合应用或不应用雷珠单抗玻璃体注射（intravitreal ranibizumab,IVR）,对增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）患者手术中操作及术后预后的影响.方法 前瞻性对照性研究.将2013年2～6月在沈阳军区总医院眼科就诊的34例（37只眼）合并牵拉性视网膜脱离的PDR患者,分为雷珠单抗玻璃体注射联合玻璃体切除术（IVR/PPV）组及单纯玻璃体切除术（PPV）组.IVR/PPV组术前1周注射雷珠单抗0.5 mg.观察两组手术中出血量（积液盒红细胞平均计数）、手术时间、术后短、长期再出血发生率及视力预后的差异.结果 随访6个月,总共29例（31只眼）最终纳入研究,其中IVR/PPV组12只眼,单纯PPV组19只眼.IVR/PPV组术中出血量（平均红细胞计数）为（79±62.24）×10^6/mL,显著低于单纯PPV组的（156.54±123.2） ×10^6/mL,差异有统计学意义（t=2.315,P=0.028）,手术时间（79.47± 15.44） min也显著低于单纯PPV组（102.08±22.2） min,差异有统计学意义（t=3.087,P=0.006）.两组患者术后视力均较术前显著提高,差异有统计学意义（t =4.92,5.75;P=0.01,0.000）,但两组间的视力预后及术后再出血发生率差异均无统计学意义（P＞0.05）.结论 术前雷珠单抗玻璃体注射,能显著减少PDR患者玻璃体切除手术中出血及手术时间,为复杂糖尿病史网膜患者的手术治疗提供了便利.Objective To assess the effect of pars plana vitrectomy （PPV） with or without preoperative intravitreal ranibizumab （IVR） injection for treatment of proliferative diabetic retinopathy （PDR）.Methods A prospective study was carried out with consecutive patients with diabetic traction retinal detachment which were underwent PPV at our department from February 2013 to June 2013.Thirty-four patients （37 eyes） were assigned to PPV only （PPV group） or PPV combined with one IVR （0.5mg/0.05ml） injection 1 week prior to surgery （IVR/PPV group）.The main outcomes included intraoperative intraocular hemorrhage （measured with erythrocyte count in the fluid retrieved from the vitrectomy cassette using a Neubauer chamber）,time of vitrectomy,postvitrectomy vitreous hemorrhage （VH） and visual acuity were assessed.All patients were followed up 6 months.Results A total of 29 patients （31 eyes） fulfilled the study included 12 eyes in the PPV group and 19 eyes in the IVR/PPV group.The mean erythrocyte count in the IVR/PPV group were 79±62.24×106 cells/ml,significantly lowed than 156.54±123.2×106 cells/ml in the PPV group （t =2.315,P =0.028）.The mean time of vitrectomy in the IVR/PPV group was 79.47± 15.44 minutes,also significantly lowed than 102.08±22.2 minutes in the PPV groups （t =3.087,P =0.006）.The postoperative visual acuity （VA） at 6 months in two groups were all significantly increased than preoperative VA respectively （t =4.92,5.75 P =0.001,0.000）.The incidences of postvitrectomy VH （whatever early VH or late VH） and postoperative VA at 6 months had no difference significantly between 2 groups.Conclusions Preoperative intravitreal ranibizumab significantly decrease intraoperative hemorrhage and time of vitrectomy,ease the procedure of operation in complex PDR patients.

关 键 词：增殖性糖尿病视网膜病变 雷珠单抗 玻璃体切除术 

分 类 号：R587.2[医药卫生—内分泌]