玻璃体腔注射雷珠单抗联合25G玻璃体视网膜手术治疗增生型糖尿病视网膜病变的临床观察  

The effect of intravitreal injection of ranibizumab combined with vitrectomy to treat proliferative diabetic retinopathy

作　　者：朱丽[1] 陈晓[1] 宋艳萍[1] 晏颖[1] 洪玲[1] 黄志坚[1] 曾苗[1] 

机构地区：[1]广州军区武汉总医院全军眼科中心,430070

出　　处：《中华眼底病杂志》2016年第1期22-25,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察手术前玻璃体腔注射雷珠单抗（IVR）对增生型糖尿病视网膜病变（PDR）患者25G微创玻璃体视网膜手术（VRS）操作过程及手术后视力的影响。方法回顾性非随机临床对照研究。临床检查确诊并接受25G微创VRS治疗的PDR患者62例70只眼纳入研究。依据手术前是否行IVR治疗将患者分为IVR联合VRS组（IVR＋VRS组）和单纯VRS组（VRS组），分别为30例34只眼和32例36只眼。IVR＋VRs组患眼于VRS前3～5d玻璃体腔注射10mg／ml的雷珠单抗0．05ml。两组患眼均由同一手术者行常规25G微创VRS。手术后随访6～18个月，平均随访时间（8．76±3．81）个月。对比分析两组患者手术时间，手术中医源性裂孔发生眼数、电凝止血次数、玻璃体腔填充物、手术后3个月内玻璃体再积血以及手术后6个月最佳矫正视力（BCVA）情况。结果两组患跟手术操作的平均时间（t--6．136）、使用眼内电凝止血的平均次数（t=6．128）比较，差异有统计学意义（P=0．000、0．036）。IVR＋VRS组、VRS组患眼医源性视网膜裂孔发生率分别为8．8％、27．8％；玻璃体腔硅油填充率分别为14．7％、38．9％。两组患眼医源性视网膜裂孔发生率以及硅油填充率比较，差异均有统计学意义（Х^2=4．154、5．171，P=0．023、o．032）。IVR＋VRS组、VRS组患眼手术后3个月内玻璃体再积血的发生率分别为11．8％、30．6％；玻璃体再积血的发生率比较，差异有统计学意义（Х^2=3．932，P=0．047）。手术后6个月，两组患眼平均BCVA均较手术前提高，差异有统计学意义（t=4．414、8．234，P=0．000）；两组患眼之间手术后平均BCVA比较，差异无统计学意义（t=0．111，P=0．190）。IVR＋VRS组患者未发生与注射及药物相关的局部及全身不良反应。结论PDR患者25G微创VRS前IVR，能缩短手术时间，减少手术中出血及医源性视网膜裂孔的发生率；降�Objective To observe the clinical effect of intravitreal ranibizumab （IVR） combined with vitrectomy in treating proliferative diabetic retinopathy （PDR）. Methods This is a prospective non-randomized controlled clinical study. A total of 62 patients （70 eyes） who underwent vitrectomy for PDR were enrolled and divided into IVR group （30 patients, 34 eyes） and control group （32 patients, 36 eyes）. IVR group patients received an intravitreal injection of 0.05 ml ranibizumab solution （10 mg/ml） 3 or 5 days before surgery. The follow-up time was 3 to 18 months with an average of （4.5± 1.8） months. The surgical time, intraoperative bleeding, iatrogenie retinal breaks, use of silicone oil, the best corrected visual acuity （BCVA） and the incidence of postoperative complications were comparatively analyzed. Results The difference of mean surgical time （t： 6. 136） and the number of endodiathermy during vitrectomy （t= 6. 128） between IVR group and control group was statistically significant （P：0.0O0, 0. 036）. The number of iatrogenic retinal break in IVR group is 8.8% and control group is 27.8 %, the difference was statistically significant （Х^2 = 4. 154, P= 0. 032）. Use of silicone oil of IVR group is 14.7% and control group is 38.9% ,the difference was statistically significant （Х^2 =5. 171, P=0. 023）. The incidence of postoperative vitreous hemorrhage in 3 month after surgery was 11.8% and 30.6 % respectively in IVR group and control group. The differences were statistically significant （Х^2 = 3. 932, P=0. 047）. The 6 month postoperative mean BCVA of IVR group and control group have all improved than their preoperative BCVA, the difference was statistically significant （t = 4. 414, 8. 234; P = 0. 000）. But there was no difference between the mean postoperative BCVA of two groups （t=0. 111, P=0. 190）. There was no topical and systemic adverse reactions associated with the drug after injection in IVR group. Conclusions Microincision vitreoretinal surger

关 键 词：糖尿病视网膜病变/药物疗法 糖尿病视网膜病变/外科学 血管生成抑制剂/治疗应用 抗体 单克隆/治疗应用 玻璃体切除术 

分 类 号：R779.6[医药卫生—眼科] R587.2[医药卫生—临床医学]