23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普治疗增生型糖尿病视网膜病变(PDR)的疗效分析  

Preoperative and intraoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy

作　　者：薛鹏程[1] 游志鹏[1] 付书华[1] 彭灵[1] 董乐[1] 

机构地区：[1]南昌大学第二附属医院眼科,江西省南昌市330006

出　　处：《眼科新进展》2017年第5期458-462,共5页Recent Advances in Ophthalmology

摘　　要：目的对比分析23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普对增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)疗效及手术相关并发症的影响。方法回顾性分析南昌大学第二附属医院2015年1月至2016年2月收治的PDR患者42例(42眼)的资料,其中22例在行23G玻璃体切割术前1周于玻璃体内注射康柏西普0.05 mL(A组);另外20例在行23G玻璃体切割术完毕时于玻璃体内注射康柏西普0.05 mL(B组)。观察两组患眼手术时间,术后玻璃体内出血情况,术中、术后其他指标及最佳矫正视力等的差异。结果 A组手术完成时间、电凝止血率、医源性裂孔发生率及术中出血率均低于B组。两组术后6个月视力比较差异无统计学意义(P>0.05),但两组术前、术后视力相比差异均有统计学意义(均为P<0.05)。术后早期玻璃体出血(≤1个月);A组有4眼(18.2%),B组有3眼(15.0%),两组相比差异无统计学意义(P>0.05)。术后晚期玻璃体出血(>1个月);A组6眼(27.3%),B组未发现玻璃体内出血,两组相比差异有统计学意义(P<0.05)。随访期间A组有3眼因术后玻璃体再出血,需再次手术,再次手术率13.6%;B组有2眼术后发生牵拉性视网膜脱离,需再次手术治疗,再次手术率10.0%。视网膜激光光凝补充治疗:A组需(2.3±1.0)次,B组需(1.4±0.6)次,两组比较差异有统计学意义(P<0.05)。结论23G玻璃体切割术中联合康柏西普治疗PDR可有效预防术后早晚期出血,为术后激光补充治疗提供有利条件,减少激光补充治疗次数;而术前联合康柏西普治疗PDR可缩短手术时间,减少术中并发症发生,降低术后早期出血率。Objective To discuss the effects and influence of preoperative and postoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative dia- betic retinopathy （PDR）. Methods A retrospective research was performed on 42 PDR eyes from January 2015 to February 2016 in the Second Affiliated Hospital of Nanchang University, who received either intravitreal 0.05 mL conbercept injection 7 days before 23 G vitrectomy （group A, n = 22） or intravitreal 0.05 mL conbercept injection at the end of 25G vitrectomy （group B ,n = 20）. The operative time,postoperative vitreous hemorrhage （VH） ,intraoperative and postoperative other differences of clinical indica- tors and postoperative best-corrected visual acuity （BCVA） between the two groups were compared. Results The average operation time,intraoperative electric coagula- tion hemostasis rate, iatrogenic hiatal incidence and intraoperative hemorrhage rate of group A were lower than those of group B （ all P 〈 0.05 ）. BCVA at 6 months after sur- gery did not differ significantly between two groups （P 〉 0.05 ）, but the difference was statistically significant between pre-operation and post-operation （P 〈 0.05 ）. The incidences of early （ ≤ 1 month） postoperative VH were 18.2% （4 eyes） and 15.0% （3 eyes） in group A and B,respectively （P 〉 0.05 ）. The incidences of later （ 〉 1 month） postop- erative VH were 27.3% （6 eyes） and 0 in group A and B,respectively,the difference was statistically significant （P 〈 0.05 ）. The percentages of reoperation were 13.5% （3 eyes with postoperative VII） and 10.0% （2 eyes with traction retinal detachment） respectively in group A and B. The average times of supplementary laser photocoagulation were （2.3 ± 1.0 ） times and （ 1.4 ± 0. 6） times in group A and B, respectively in follow-up period （P 〈 0.05 ）. Conclusion The adjunctive use of intraoperative intravitreal injection of conbercept can prevent effectively postoperative VH and decrease

关 键 词：23G玻璃体切割 康柏西普 增生型糖尿病视网膜病变 血管内皮生长因子 

分 类 号：R774.1[医药卫生—眼科]