雷珠单抗预防伴有虹膜新生血管的糖尿病视网膜病变术后再出血疗效观察  

Lucentis preventing vitreous hemorrhage after vitrectomy for diabetic retinopathy combined with iris neovascularization

作　　者：毛子清 游志鹏[1] 周五剑 罗文彬[1] 李佳[1] 吴超[1] 

机构地区：[1]南昌大学第二附属医院眼科毛子,江西省南昌市330006 [2]南昌大学第一附属医院血液内科,江西省南昌市330006

出　　处：《眼科新进展》2017年第6期539-543,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81460088)~~

摘　　要：目的研究雷珠单抗预防伴有虹膜新生血管的糖尿病视网膜病变玻璃体切割术后再出血的疗效。方法回顾性分析2009年至2015年在我院因糖尿病视网膜病变行玻璃体切割术后出现虹膜新生血管的患者70例(70眼)的临床资料。对照组30例(30眼)行全视网膜激光光凝,多次玻璃体手术、睫状体冷冻等治疗,研究组40例(40眼)术前玻璃体内注射雷珠单抗0.5 mg后联合各项治疗,随访3个月,对比分析两组患者视力、眼压、新生血管消退及并发症等情况。结果术后1个月、2个月时,研究组视力优于对照组,但随着时间的延长,两组视力无明显差异。研究组、对照组术前眼压分别为(26.312±4.566)mmHg(1 kPa=7.5 mmHg)、(25.586±5.783)mmHg,两组相比差异无统计学意义(P=0.687);随访期末眼压分别为(18.576±4.762)mmHg、(28.587±7.786)mmHg,两组相比差异有统计学意义(P=0.041)。对照组术中、术后出现前房和(或)玻璃体积血者分别为12例、5例,研究组为3例、1例,两组术中、术后积血比例相比差异均有统计学意义(均为P=0.000)。随访期末研究组3眼(7.5%)进展为新生血管性青光眼,对照组为10眼(33.3%),两组相比差异有统计学意义(P<0.05)。结论糖尿病视网膜病变术后伴有虹膜新生血管时,雷珠单抗可以有效消除新生血管,减少新生血管性青光眼的发生率,并减少前房、玻璃体积血的发生率,在一定时间内有效提高患者视力。Objective To study the effects of lucentis preventing vitreous hemor- rhage after vitrectomy for diabetic retinopathy combined with iris neovascularization. Methods The clinical data of 70 patients （70 eyes） underwent vitrectomy for diabetic retinopathy combined with iris neovascularization during 2009 to 2015 in our hospital were retrospectively analyzed. The control group （ 30 eyes） accepted panretinal photo- coagulation （ PRP）, re-vitrectomy, cyclocryotherapy, and the study group （40 eyes） had the 0.5mg lucentis in addition. The follow-up time was 3 months,and the visual acuity, IOP,vitreous hemorrhage, INV regression and complication were observed. Results At 1 month,2 months in the follow-up,the visual acuity of study group was better than the control group, but there was no significant difference along with the follow up. The average preoperative IOP was （25.312 ＋4.566） mmHg （ 1 kPa =7.5 mmHg） in the study group and （24.585 _＋5. 783） mmHg in the control group,and at the end of the follow up, IOP was （ 18.576 _＋4.752） mmHg in the study group and （28.587 _＋7.786） mmHg in the control group,there was statistical difference between the two groups （P=O. 041 ）. The intraoperative and postoperative anterior chamber or vitreous hemorrhage occurred in 15 cases,5 cases of the control group,and 3 cases, 1 case of the control group,there were significant differences （ all P = 0.000）. At the end of the follow up, 3 eyes （7.5%） developed to NVG in the study group and l0 eyes （33.3%） in the control group, there was statistical difference （P 〈 0.05 ）. Conclusion Lucentis can effectively eliminate the new vessels, reduce the incidence of neovascularization glaucoma and vitreous hem- orrhage for patients after vitrectomy for diabetic retinopathy combined with iris neovas- cularization, and improve the visual acuity in a short time.

关 键 词：虹膜新生血管 雷珠单抗 糖尿病视网膜病变 视网膜激光光凝 

分 类 号：R774.1[医药卫生—眼科]