内界膜剥除治疗顽固性糖尿病黄斑水肿的观察  

Observation on the efficacy of internal limiting membrane peeling for refractory diabetic macular edema

作　　者：李秀娟[1] 关微 

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2018年第2期85-88,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省科技厅科技攻关项目（142102310110）;河南省卫生和计划生育委员会项目（2014005）;河南省卫生厅科技攻关项目（201304007）

摘　　要：目的观察玻璃体切除联合内界膜剥除术治疗顽固性糖尿病黄斑水肿的效果。方法回顾性分析2014年6月至2015年11月增生期糖尿病视网膜病变伴顽固性黄斑水肿80例（80只眼）的临床资料。患者随机分成两组，每组40例。A组：雷珠单抗玻璃体内注射，1周后行玻璃体切除术，术中联合广泛视网膜光凝；B组：在A组手术基础上联合视网膜内界膜剥除。术前两组患者在年龄、性别、最佳矫正视力、黄斑中心视网膜厚度和眼压等方面差异均无统计学意义（P〉0．05）。术后随访6个月。结果末次随访时，B组的最佳矫正视力（10gMAR）为0．46±0．23，优于A组的0．54±0．19，差异有统计学意义（t=3．125，P=0．000）；两组术后最佳矫正视力均较术前明显提高（P=0．000）。末次随访时，B组黄斑中心视网膜厚度为（256．32±52．65）μm，低于A组的（271．65±56．72）μm，差异有统计学意义（t=3．294，P=0．004）。两组术后黄斑中心区厚度较术前均有明显的下降（P=0．000）。结论雷珠单抗联合玻璃体切除术是治疗顽固性糖尿病黄斑水肿的有效方法，术中联合内界膜剥除能明显提高手术的效果。Objective To observe the efficacy of vitreetomy and retinal internal limiting membrane peeling for the treatment of refractory diabetic maeular edema. Methods The data of 80 eyes of 80 patients with refractory diabetic macular edema from Jun. 2014 to Nov. 2015 were collected and retrospectively analyzed. They were divided randomly into two groups ： group A and group B, every group included 40 eyes. All cases underwent intravitreal injection of ranibizumab first, and 7 days after injection 40 cases in group A underwent pars plana vitrectomy combined with panretinal photoeoagulation. In group B ,40 eases underwent surgery the same as that in group A and they received retinal internal limiting membrane peeling during vitreetomy. Preoperatively, the difference in age, gender, best corrected visual acuities （ BCVA）, central maeular retinal thickness and intraoeular pressure were not statistically significant between the two groups （ P 〉 0.05 ）. The follow-up period was 6 months. Results At the end of follow-up, the postoperative BCVA （logMAR） was 0.46±0.23 in group B and 0.54 ± 0. 19 in group A. The difference was statistically significant between the two groups （ t = 3. 125, P = 0. 000）. The postoperative BCVA of two groups improved obvious （P =0. 000）. At the last follow-up, the central macular retinal thickness in group B was （256.32± 52.65） μm, which was lower than that in group A （271. 65 ± 56. 72 ） μm, and the difference was statistically significant （ t = 3. 294, P = 0. 004）. The cental macular retinal thickness of the two groups after surgery decreased significantly （ P =0. 000）. Conclusion Intravitreal injection of ranibizumab combined with vitrectomy is an effective method for the treatment of refractory diabetic macular edema. During surgery combined with internal limiting membrane peeling can obviously improve the efficacy.

关 键 词：黄斑水肿 糖尿病 顽固性 玻璃体切除术 内界膜剥除术 

分 类 号：R587.2[医药卫生—内分泌] R779.6[医药卫生—内科学]