不同方法治疗糖尿病黄斑水肿的对比观察  

Comparison of efficacy of different methods for diabetic macular edema

作　　者：田军[1] 

机构地区：[1]郑州市第二人民医院郑州市眼科医院郑州市眼科研究所,450006

出　　处：《中华眼外伤职业眼病杂志》2015年第7期534-538,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评价玻璃体内注射雷珠单抗（Ranibizumab）和联合黄斑格栅样光凝治疗糖尿病黄斑水肿的临床疗效和安全性。方法糖尿病黄斑水肿60例（60眼）随机分为3组，每组20例。A组，玻璃体内每月注射雷珠单抗1次，连续3次，于第1次注药后1周行黄斑格栅样光凝；B组，玻璃体内每月注药1次，连续3次；C组，玻璃体内仅注药1次。随访6个月，比较3组患者在雷珠单抗注射后1、3、6个月时的最佳矫正视力（BCVA）及黄斑中心区厚度（CMT）。结果A组治疗后1、3、6个月时的BCVA和CMT与治疗前相比差异均有统计学意义（P〈0．05），且随访期内疗效保持稳定。B组治疗后1、3、6个月时的BCVA和CMT与治疗前相比差异均有统计学意义（P〈0．05），但随访期间BCVA呈下降趋势，CMT呈上升趋势。C组治疗后1个月时BCVA和CMT与治疗前比较，差异有统计学意义（P〈0．05），但BCVA于治疗后3月时降至治疗前水平；CMT于治疗后6个月时恢复至治疗前水平。结论雷珠单抗连续3次注射联合和不联合黄斑格栅样光凝均能有效控制DME病情发展并改善视力，两种疗法的短期疗效比较差异无统计学意义，但术后6个月联合光凝组稳定性优于不联合光凝组。两组疗效均优于单次注射组。Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with macular grid photocoagulation for diabetic macular edema （DME）. Methods Totally 60 eyes of 60 patients with DME were randomly divided into three groups with 20 cases in each group. Patients in group A received intravitreal ranibizumab injection every 4 weeks for 3 months and macular grid photocoagnlation was performed 1 week later. Patients in group B received intravitreal injection of ranibizumab with same dose and same frequency without macular grid photocoagulation. Patients in group C received intravitreal injection of ranibizumab only once. At 1,3 and 6 months follow-up after the first injection, the changes of best corrected visual acuity （BCVA） and center macular thickness （CMT） between 3 groups were compared. Results In group A, the BCVA and CMT after injection were satisfactory and steady during follow-up （ all P 〈 0.05 ）. In group B, 1,3 and 6 months after the first injection, the BCVA and CMT were much better than that before the operation （ all P 〈 0.05 ）, but during follow-up, the BCVA decreased and the CMT increased slowly. In group C, the difference in BCVA was not statistically significant between preoperation ,3 and 6 months （ all P 〉 0.05 ）. The CMT had no statistically significant difference between pre-operation and 6 months after the treatment （P 〉 0.05 ）. Conclusion Successive intravitreal injection of ranibizumab combined with macular grid photocoagnlation can effectively improve visual acuity and decrease central macula thickness for patients with DME. But the stability at postoperative 6 months of the combined treatment group is better than successive intravitreal injection therapy group. The successive intravitreal injection method with or without macular grid photocoagulation is better than monoinjection therapy.

关 键 词：糖尿病视网膜病变 黄斑水肿 雷珠单抗 格栅样光凝 

分 类 号：R774.5[医药卫生—眼科]