玻璃体腔注射雷珠单抗对增生型糖尿病视网膜病变患眼微创玻璃体切割手术及手术后视力的影响  

The effect of microincision vitrectomy and intravitreal injection of ranibizumab in the treatment of proliferative diabetic retinopathy

作　　者：魏雁涛[1] 蒋欣桐[1] 张钊填[1] 周学智[1] 邱梭[1] 杨渊喆 张少冲[1] 

机构地区：[1]中山大学中山眼科中心 眼科学国家重点实验室,广州510060

出　　处：《中华眼底病杂志》2015年第4期337-340,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的：观察玻璃体腔注射雷珠单抗（IVR）对增生型糖尿病视网膜病变（PDR）患眼微创玻璃体切割手术及手术后视力的影响。方法前瞻性随机对照研究。临床确诊为 PDR 并行微创玻璃体切割手术治疗的92例患者92只眼纳入研究。手术前7~14 d 行 IVR 治疗者48只眼作为药物联合治疗组；未行IVR 治疗者44只眼作为单纯手术治疗组。两组患眼均由同一医生完成微创玻璃体切割手术。观察记录两组患眼手术中电凝及眼内填充物使用率、医源性裂孔发生率以及手术时间。手术后平均随访时间（14.3±5.2）个月。对比分析两组患眼手术后最小分辨角对数（logMAR）最佳矫正视力（BCVA）和并发症的发生情况。结果药物联合治疗组、单纯手术治疗组手术时间分别为（59.4±18.5）、（74.6±16.2）min。药物联合治疗组手术时间较单纯手术治疗组明显缩短,差异有统计学意义（t=-2.703,P 〈0.05）。药物联合治疗组手术中电凝使用率（χ2=8.039）、硅油（χ2=4.619）及惰性气体（χ2=4.290）填充率、医源性裂孔发生率（χ2=4.330）均较单纯手术治疗组明显下降,差异有统计学意义（P 〈0.05）。药物联合治疗组、单纯手术治疗组手术后平均 logMAR BCVA 分别为0.83±0.44、1.37±0.53；均较手术前明显提高,差异有统计学意义（t=3.257、3.012,P〈0.05）。药物联合治疗组手术后平均 logMAR BCVA 较单纯手术治疗组明显提高,差异有统计学意义（t=2.972,P 〈0.05）。药物联合治疗组、单纯手术治疗组手术后玻璃体再积血发生率分别为2.1%、9.1%。两组间手术后玻璃体再积血发生率比较,差异有统计学意义（χ2=6.741,P 〈0.05）。所有患眼均未发生脉络膜脱离、视网膜脱离、眼内炎等并发症。结论PDR 患眼微创玻璃体切割手术前 IVR 可缩短手术时间,减少手术中电凝、眼内填充物的使用率和医源性损伤,提高患眼视力。Objective To observe the effect of microincision vitrectomy assisted with intravitreaI injection of ranibizumab （IVR）in proliferative diabetic retinopathy （PDR）treatment.Methods This is a prospective,randomized,and comparative case series study.A total of 92 patients （92 eyes）with PDR were recruited to have microincision vitrectomy with （combined group）or without （PPV group）IVR.There are 48 eyes in the combined group and 44 eyes in the PPV group.The average operation time,iatrogenic breaks,the use of tamponade and electric coagulation,postoperative bleeding and best corrected visual acuity were comparatively analyzed among the two groups.The mean follow-up was （14.3 ±5.2）months. Results The average operation time was （59.4±18.5）min in the combined group and （74.6±1 6.2）min in the PPV group.The rate of silicone oil tamponade （χ2 =4.61 9）,inert gas tamponade （χ2 =4.290）,electric coagulation （χ2 = 8.039 ）and iatrogenic breaks （χ2 = 4.330 ）in the combined group were significantly decreased compared with PPV group （P〈0.05 ）.The mean logMAR BCVA was 0.83 ±0.44 in the combined group and 1.37±0.53 in the PPV group,which significantly improved from preoperatively （t =3.257,3.012;P〈0.05）.The rate of BCVA improvement in the combined group was significantly higher than that in the PPV group （t=2.972,P 〈0.05）.The incidence of the recurrent vitreous hemorrhage was 2.1% in the combined group and 9.1% in the PPV group （χ2 = 6.741,P 〈 0.05 ）.There was no severe complication associated with surgery,such as choroidal detachment,retinal detachment and endophthal-mitis.Conclusion IVR before the microincision vitrectomy can shorten the operation time,reduce the use of electric coagulation and intraocular tamponade,and improve visual acuity for PDR patients.

关 键 词：糖尿病视网膜病变/外科学 糖尿病视网膜病变/药物疗法 抗体 单克隆/治疗应用 血管抑制素类 玻璃体视网膜手术 

分 类 号：R587.2[医药卫生—内分泌] R779.6[医药卫生—内科学]