玻璃体腔注射雷珠单抗联合超全视网膜光凝治疗视盘新生血管型糖尿病视网膜病变  

Intravitreal injection with Ranibizumab combined with extra panrentinal photocoagulation for proliferative diabetic retinopathy with disc neovascularization

作　　者：杨乐[1] 薛雨顺[1] 石蕊[1] Le Yang;Yu-Shun Xue;Rui Shi(Department of Ophthalmology,Shaanxi Provincial People's Hospital,Xi'an 710068,Shaanxi Province,China)

机构地区：[1]陕西省人民医院眼科,中国陕西省西安市710068

出　　处：《国际眼科杂志》2018年第9期1710-1712,共3页International Eye Science

基　　金：陕西省社发项目(No.2017SF-249)~~

摘　　要：目的:观察玻璃体腔注射雷珠单抗(intravitreal ranibizumab,IVR)联合超全视网膜光凝术(extra-panretinal photocoagulation,E-PRP)治疗视盘新生血管型糖尿病视网膜病变(diabetic neovascularization on the disc,DNVD)的临床疗效。方法:对临床确诊的DNVD患者32例36眼进行IVR联合E-PRP治疗。对比观察治疗前后视力、视网膜神经纤维层厚度(retinal nerve fiber layer,RNFL)、视网膜新生血管消退等情况。结果:治疗前BCVA经LogMAR转换后为0.89±0.35,治疗后6mo为0.42±0.13,与治疗前相比差异有统计学意义(P<0.01)。19眼(53%)BCVA提高2行及以上,14眼(39%)无变化,3眼(8%)视力下降>1行。IVR+E-PRP治疗后6mo时RNFL厚度为110.64±12.06μm,与治疗前及IVR治疗后7d时RNFL厚度值相比,差异均有统计学意义(t=5.612、3.304,P<0.05)。IVR+E-PRP治疗后6mo时FFA检查32眼(89%)视盘新生血管消退,4眼(11%)新生血管无变化或加重。其中25眼(69%)经过一次E-PRP有效,7眼(19%)需追加1次激光,4眼(11%)最终未能控制病情行玻璃体手术。结论:IVR联合E-PRP治疗可促使视盘新生血管消退,减轻血管渗漏和出血,提高了DNVD治疗的有效性和安全性。·AIM:To evaluate the therapeutic effect of intravitreal injection of ranibizumab(IVR)combined with extra panrentinal photocoagulation(E-PRP)for diabetic neovascularization on the disc(DNVD).·METHODS:A total of 36 eyes of 32 patients with DNVD underwent IVR combined with E-PRP.The examinations of visual acuity,funds fluorescein angiography(FFA)and optical coherence tomography(OCT)were performed on all of the patients before and 6mo after the treatment;the result of the examinations before and after the treatment were compared and analyzed.·RESULTS:Before the treatment,best corrected visual acuity(BCVA,LogMAR)was 0.89±0.35,6mo after treatment was 0.42±0.13;the difference was significant(P<0.01).After the treatment,BCVA was improved in 19 eyes(53%),unchanged in 14 eyes(39%)and decreased in 3 eyes(8%).Retinal nerve fiber layer(RNFL)was 110.64±12.06μm at 6mo after IVR+E-PRP,which was significantly different to those before treatment and 7d after treatment(t=5.612,3.304;P<0.05).Neovascularization regressed in 32 eyes(89%),and unchanged or aggravated in 4 eyes(11%).The results of FFA after E-PRP showed that the one-off efficiency of EPRP was 69%(25 eyes),7 eyes(19%)need an additional laser,in which 4 eyes(11%)underwent vitreous surgery.·CONCLUSION:IVR combined with E-PRP as a treatment for DNVD may improve the regression of retinal neovascularization and the reduction of vascular permeability,and improve the therapeutic effect and safety.

关 键 词：雷珠单抗 超全视网膜光凝 糖尿病视网膜病变 视盘新生血管 

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