不同药物玻璃体腔注射治疗弥漫性糖尿病性黄斑水肿的疗效观察  

Efficacy of different cost of intravitreal injection in the treatment of diffuse diabetic macular edema

作　　者：董明霞[1] 李冬育 董如娇[1] 赵霞[1] 韩俊莹 陈芳[1] 

机构地区：[1]唐山市眼科医院糖网病科,唐山063000

出　　处：《中国实用眼科杂志》2015年第9期980-984,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 评价单次玻璃体腔注射雷珠单抗（Ranibizumab）或曲安耐德（Triamcinolone acetonide,TA）作为弥漫性糖尿病性黄斑水肿（DME）激光治疗前辅助治疗手段的疗效及安全性.方法 回顾性病例系列研究.对2013年1月至2014年2月在唐山市眼病医院就诊的27例（32只眼）弥漫性DME患者,将其分为IVR（玻璃体腔注射雷珠单抗）治疗组及IVTA（玻璃体腔注射曲安耐德）治疗组,术后4周行黄斑格栅样光凝术,观察注射上述两种药物后第1,2,4,8,12周最佳矫正视力（BCVA）、黄斑中心厚度（CMT）及黄斑区平均视网膜厚度（AVG）的变化情况及术后并发症的发生情况.结果 对两组治疗前后BCVA、CMT及AVG各时间点的平均计量数据行t检验分析发现,三项指标两组治疗后均较治疗前有明显改善（P＜0.05）,差异有统计学意义.对两组治疗后对应时间点的BCVA、CMT及AVG变化的有效计数资料行X-squared检验比较分析发现,两组对应时间点相比治疗效果差异均无统计学意义（P＞0.05）.治疗后4～8周,IVTA组并发眼压升高2例（2眼）,并发白内障1例（1眼）;IVR组均无上述情况发生.结论 单次玻璃体腔注射低剂量TA与单次玻璃体腔注射Ranibizumab治疗弥漫性DME短期内均有效,二者获益率相当,无统计学意义,IVR治疗的安全性略优于IVTA.但单次IVTA治疗DME是相对安全的,且治疗成本低.对于低收入DME患者来说,IVTA可作为首选治疗。Objective Evaluate the effection and safety of single Intravitreal injected Ranibizumab or triamcinolone acetonide（TA） which were auxiliary treatment of diffuse diabetic macular edema （DME） before laser treatment.Methods 27 Cases （32 eyes） with diffuse DME were analysed retrospectively, divided the patients into IVR （Intravitreal injection of Ranibizumab） group and IVTA （Intravitreal injection of TA）group,both two groups made macular laser grid photocoagulation in the four week after operation,observed the changes of best corrected visual acuity （BCVA）, centre of macular thickness （CMT） and average of macular retinal thickness （AVG） after 1,2,4,8,12 weeks ,and the incidence of complication.Result Through t test analysed the average measurement datas of BCVA, CMT and AVG at each time point before and after treatment in each group,three indexes were all improved after treatment （P 〈0.05）, they were significant.Through X-squared test analysed the effective comparative datas of BCVA, CMT and AVG at each time point after treatment between two groups, the treatment effect of two groups showed no significant statistical differences （P 〉0.05）.In IVTA group,2 cases（2 eyes） appeared elevated intraocular pressure and 1 case（1 eye） appeared catatact at 4 to 8 weeks after treatment;there is nothing happened in IVR group.Conclusions Single Intravitreal injection of TA or Ranibizumab which treated diffuse DME in the short term are effective, they had the same benefit rate, with no statistically significant differences, the safety of IVR was better than IVTA.Single IVTA is relatively safe and low treatment costs to treat DME.IVTA could be used as the preferred treatment for low-income patients with DME.

关 键 词：雷珠单抗 曲安奈德 糖尿病性视网膜病变 弥漫性黄斑水肿 玻璃体腔注射 

分 类 号：R587.2[医药卫生—内分泌]