雷珠单抗玻璃体内注射、全视网膜光凝和黄斑光凝联合治疗糖尿病黄斑水肿的临床疗效  

Clinical Effect of Treatment with a Combination of Lucentis Intravitreal Injection and Whole Retinal and Macular Photo Coagulation in Patients with Diabetic Macular Edema

作　　者：于秀玲[1] 徐丽[1] 刘驰[1] YU Xiuling;XU Li;LIU Chi(Department of Ophthalmology,The Fourth People’s Hospital of Shenyang,Shenyang 110031,China)

机构地区：[1]沈阳市第四人民医院眼科,沈阳110031

出　　处：《中国医科大学学报》2018年第11期1011-1014,共4页Journal of China Medical University

基　　金：沈阳市科学技术计划(F16-206-9-25)

摘　　要：目的评价单纯玻璃体内注射雷珠单抗注射液、单纯采用全视网膜光凝联合黄斑格栅样光凝和玻璃体内注射雷珠单抗注射液联合全视网膜光凝同时黄斑格栅样光凝治疗糖尿病黄斑水肿(DME)的临床疗效。方法通过光学相干断层扫描(OCT)和眼底荧光血管造影(FFA)筛选符合条件的DME患者(共60眼),随机分为3组:单纯注药组(开始时、4周、8周时注药),单纯激光组(全视网膜光凝同时黄斑格栅样光凝治疗)和玻璃体内注射雷珠单抗注射液联合全视网膜光凝同时黄斑格栅样光凝联合治疗组(联合治疗组,于注药1周行全视网膜光凝同时黄斑格栅样光凝治疗),每组各20眼。比较3组治疗后1周、4周、8周、12周的最佳矫正视力(BCVA)及黄斑中心凹视网膜厚度(CMT)变化。结果联合治疗组注药后1、4、8、12周BCVA和CMT与术前及组间比较均有统计学差异(均P <0.05)。单纯注药组在相应时间点BCVA和CMT与术前比较有统计学差异(P <0.05),与单纯激光组8周内比较有统计学差异(P <0.05),12周2组间比较无统计学差异(P> 0.05)。单纯激光组术后4周BCVA和CMT与术前比较无统计学差异(P> 0.05),12周时与术前比较有统计学差异(P <0.05)。联合治疗组与单纯注药组治疗后与术前比较BCVA均明显提高;联合治疗组治疗后12周与8周时比较BCVA显著升高。单纯激光组术后4周内视力提高不明显,个别患者加重黄斑水肿、视力下降,但8周后与单纯注药组比较无明显差异。结论玻璃体内注射雷珠单抗注射液联合全视网膜光凝同时黄斑格栅样光凝治疗DME能够有效提高患者视力,降低CMT。Objective To evaluate the clinical effect,including best corrected visual acuity(BCVA),of lucentis intravitreal injection,photocoagulation,and combined lucentis intravitreal injection and photocoagulation,in patients with diabetic macular edema.Methods In total 42 patients(60 eyes)with edema were randomly divided into three groups:the combined group(treated with lucentis intravitreal injection and laser therapy),injection group(treated with lucentis intravitreal injection alone),and laser group(laser treatment alone).We compared the treatment effects among the three groups,including the impact on the central retinal thickness(CMT),and BCVA.Results After treatment for 1,4,8,and 12 weeks,the CMT and BCVA in the combined group and the injection group were significantly different from those before treatment(P<0.05,each).After treatment for 8,and 12 weeks,the CMT and BCVA in the laser group were significantly different from those before treatment(P<0.05,each).The BCVA in the combined group and the injection group were significantly higher than that before treatment.After treatment for 1 and 4 weeks,the BCVA in the laser group did not increase from that before treatment;moreover,the individual patients showed aggravated macular edema,resulting in decreased vision.After treatment for 8 weeks,the BCVA in the laser group did not increase significantly in comparison to the injection group.Conclusion The combination of lucentis intravitreal injection and laser treatment in patients with diabetic macular edema showed synergistic effects to significantly reduce macular edema-induced CMT and improve BCVA.

关 键 词：糖尿病视网膜病变/并发症 黄斑水肿 雷珠单抗 全视网膜光凝 黄斑格栅样光凝 联合治疗 

分 类 号：R587.2[医药卫生—内分泌]