不同光相干断层扫描分型糖尿病黄斑水肿患眼玻璃体腔注射雷珠单抗与激光光凝治疗后视力观察  

The visual acuity changes in patients with different patterns of optical coherence tomography of diabetic macular edema after intravitreal ranibizumab injection and/or laser photocoagulation

作　　者：王相宁[1] 李淑婷[1] 杜新华[1] 陈永东[1] 吴强[1] 

机构地区：[1]上海交通大学附属第六人民医院眼科,200233

出　　处：《中华眼底病杂志》2017年第2期134-138,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察不同光相干断层扫描（OCT）分型糖尿病黄斑水肿（DME）患眼玻璃体腔注射雷珠单抗与激光光凝治疗后视力变化情况.方法 回顾性研究.临床确诊为DME的70例患者99只眼纳入研究.所有患眼均采用国际标准视力表检测最佳矫正视力（BCVA）,并将结果转换为最小分辨角对数（logMAR）视力进行记录.所有患眼均行OCT检查,并根据OCT形态特征将DME分为弥漫性黄斑水肿（DRT）、黄斑囊样水肿（CME）、浆液性神经上皮层脱离3种类型.根据治疗方案不同将患者分为单纯玻璃体腔注射雷珠单抗治疗组（A组）、玻璃体腔注射雷珠单抗联合激光光凝治疗组（B组）及单纯激光光凝治疗组（C组）,分别为21例25只眼、23例26只眼、26例48只眼.治疗后平均随访时间（80.43±74.89）d.对比分析3组患眼及不同OCT分型患眼BCVA绝对变化（ABCVA）以及视力提高眼数所占比例.ABCVA=治疗前logMAR BCVA-治疗后logMARBCVA.以BCVA的logMAR值提高0.3以上为视力提高.结果 A、B、C组患眼ABCVA比较,差异无统计学意义（F=0.050,P＞0.05）.A、B组患眼视力提高眼数所占比例较C组高,差异有统计学意义（x2=5.645、6.301,P＜0.05）.A、B、C组组内不同OCT分型患眼ABCVA及视力提高眼数所占比例比较,差异无统计学意义（P＞0.05）.A、B组DRT、CME患眼视力提高眼数所占比例分别为70.59％、50.00％;C组DRT、CME患眼视力提高眼数所占比例26.47％、14.29％.A、B组DRT、CME患眼视力提高眼数所占比例较C组更高,差异有统计学意义（x2=5.075、4.453,P＜0.05）.结论 不同OCT分型DME患眼经玻璃体腔注射雷珠单抗和（或）激光光凝相同治疗方案治疗后视力变化无明显差异;相同OCT分型DME患眼经不同治疗方案治疗后,视力提高眼数所占比例有差异.Objective To observe the visual acuity change in patients with different patterns of optical coherence tomography （OCT） of diabetic macular edema （DME） after intravitreal ranibizumab injection and/or laser photocoagulation.Methods A retrospective observational case series.Seventy patients （99 eyes） with DME were enrolled.Best-corrected visual acuity （BCVA） was evaluated using the international vision test chart,and then convert the result to the logarithm of the minimum angle of resolution （logMAR）.According to the morphological characteristics of OCT,the DME was divided into 3 patterns,including diffuse macular edema （DRT）,cystoid macular edema （CME） and serous neuroepithelial layer detachment.The average follow-up was （80.43 ± 74.89） days.The patients were divided into 3 groups according to the different treatments,including intravitreal ranibizumab injection group （group A,21 patients,25 eyes）,intravitreal ranibizumab injection and laser photocoagulation group （group B,23 patients,26 eyes）,laser photocoagulation group （group C,26 patients,48 eyes）.The changes of absolute BCVA （ABCVA） and improved visual acuity were compared between different treatment groups and different OCT patterns.ABCVA =logMAR BCVA before treatment-logMAR BCVA after treatment.Improvement more than 0.3 of logMAR value was considered as improved visual acuity.Results There was no significant difference in ABCVA between different treatment groups （F=0.050,P〉0.05）.The improved visual acuity in group A and B were great than group C （x^2=5.645,6.301;P〈0.05）.In group A,B and C,there was no significant difference in ABCVA and improved visual acuity between different OCT patterns （P〉0.05）.Improved visual acuity of DRT and CME eyes were higher in group A＆B （70.59% and 50.00%） than in group C （26.47% and 14.29%）,the difference was statistically significant （x^2=5.075,4.453;P〈0.05）.Conclusions There is no obvious change of visual acuity in patients with different OCT p

关 键 词：糖尿病视网膜病变/治疗 黄斑水肿/治疗 血管生成抑制剂/治疗应用 抗体 单克隆/治疗应用 激光凝固术 体层摄影术 光学相干 

分 类 号：R587.2[医药卫生—内分泌] R779.63[医药卫生—内科学]