术前及术中2次应用康柏西普辅助玻璃体切割术治疗增生型糖尿病视网膜病变的临床研究  

Clinical observation of the application of conbercept preoperatively and intraoperatively assisted to the vitrectomy in the treatment of proliferative diabetic retinopathy

作　　者：梁泽玉[1] 陈松[1] 何广辉[1] 王俊华 高翔 武斌[1] LIANG Ze-Yu;CHEN Song;HE Guang-Hui;WANG Jun-Hua;GAO Xiang;WU Bin(Clinical College of Ophthalmology of Tianjin Medical University,Tianjin Eye Hospital,Tianjin Key Lab of Ophthalmology and Visual Science,Tianjin Eye Institute,Tianjin 300020,China)

机构地区：[1]天津医科大学眼科临床学院天津市眼科医院天津市眼科学与视觉科学重点实验室天津市眼科研究所,天津市300020

出　　处：《眼科新进展》2019年第2期162-167,共6页Recent Advances in Ophthalmology

摘　　要：目的对比并分析术前1次、术前及术中2次玻璃体内注射康柏西普(intravitreal injection conbercept,IVC)辅助玻璃体切割术(pars plana vitrectomy,PPV)治疗增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者术中及术后临床指标的不同。方法回顾性随机病例对照研究,依据纳入及排除标准将确定为严重PDR患者并需行PPV治疗的158例162眼纳入研究。依据IVC次数分为3组:A组为单纯PPV组48例50眼,B组为术前1次IVC组61例63眼,C组为术前及术中2次IVC组49例49眼。3组患眼临床基线资料差异均无统计学意义(均为P> 0. 05)。所有患眼手术操作均由同一名术者完成,统计并分析3组患眼的PPV手术时间、术中严重出血率、术后玻璃体内积血(postoperative vitreous cavity haemorrhage,POVCH)发生率、术后不同时间POVCH发生率、术后不同程度POVCH发生率、术后1个月与3个月最佳矫正视力(best corrected visual a-cuity,BCVA)、术后1个月与3个月BCVA提高率。结果 B组、C组的PPV手术时间[(87. 85±12. 37) min、(88. 45±13. 66)min]及术中严重出血发生率(12. 70%、12. 24%)均低于A组[(91. 02±17. 90) min、34. 00%](F=24. 709,P <0. 05;χ~2=11. 330,P <0. 05); C组术后3个月内POVCH发生率及严重出血程度均低于A组、B组(均为P <0. 05); C组术后POVCH出血程度均轻于A组、B组,C组术后1个月BCVA均高于A组、B组,C组术后1个月及术后3个月BCVA提高率分别高于A组及B组(χ~2=14. 038,P <0. 05;χ~2=11. 076,P <0. 05)。结论 PPV术前及术中2次IVC可有效降低PDR患者术后短期(1个月)内POVCH的发生率,减轻POVCH出血程度,改善PDR患者术后视力。Objective To compare the differences in the clinical parameters of proliferative diabetic retinopathy(PDR)patients underwent pars plana vitrectomy(PPV)received the treatment of the intravitreous injection of conbercept(IVC)single time preoperatively or two times preoperatively and intraoperatively.Methods A retrospective randomized case-control study was conducted.There were 162 eyes of 158 patients with PDR underwent PPV included into the study according to inclusion and exclusion criteria.The patients were divided into 3 groups according to the frequency of IVC:50 eyes of 48 patients as group A received no IVC,63 eyes of 61 patients as group B who received single IVC preoperatively and 49 eyes of 49 patients as group C received twice IVC preoperatively and intraoperatively.There were no statistically significant differences in the clinical subjective baseline of three groups(all P >0.05).All the patients underwent the operations by the same operator.The analysis included the mean operative time of PPV,the rate of intraoperative hemorrhage,the rate of postoperative vitreous cavity hemorrhage(POVCH)at 1 month and 3 months during the follow-up,the degree of the POVCH and the visual acuity distribution at 1 month and 3 months postoperatively,the rate of visual acuity improvement at 1 month and 3 months postoperatively.Results The mean operative time[(87.85±12.37)min,(88.45±13.66)min]and the rate of severe intraoperative hemorrhage(12.70%,12.24%)of group B and C were lower than those of group A[(91.02±17.90)min,34.00%](F=24.709,P<0.05;χ^2=11.330,P<0.05).The rate and the degree of POVCH of group C were lower than those of group A and group B during the follow-up(both P<0.05);the degree of POVCH of group C was lower than that of the other groups during follow-up.The improvement of best corrected visual acuity(BCVA)of group C was better than that of the other groups at 1-month postoperatively.The rate of BCVA improvement of the group C at the 1-month and 3-month were significantly higher than that of the other grou

关 键 词：增生型糖尿病视网膜病变 康柏西普 玻璃体切割术 玻璃体内积血 

分 类 号：R774.1[医药卫生—眼科]