微创玻璃体手术联合与不联合抗VEGF药物治疗PCV合并玻璃体积血疗效观察  

Efficacy of minimally invasive vitreous surgery combined with or without anti-VEGF drug injection in PCV complicated with vitreous hemorrhage

作　　者：许腾予 李甦雁 张正培 刘海洋 季苏娟 刘亚鲁 徐青 Xu Tengyu;Li Suyan;Zhang Zhengpei;Liu Haiyang;Ji Sujuan;Liu Yalu;Xu Qing(Department of Ophthalmology,The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University,Xuzhou First People's Hospital,Xuzhou Eye Disease Prevention and Treatment Institute,Xuzhou 221116,China)

机构地区：[1]徐州医科大学附属徐州市立医院眼科,徐州市第一人民医院,徐州市眼病防治研究所,徐州221116

出　　处：《中华实验眼科杂志》2022年第7期651-657,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：徐州市卫生杰出人才项目(XWJC001);徐州市科技计划项目(KH17030)。

摘　　要：目的比较微创玻璃体手术联合与不联合抗血管内皮生长因子(VEGF)药物治疗息肉样脉络膜血管病变(PCV)合并玻璃体积血的临床效果。方法采用队列研究方法,连续收集2015年6月至2020年6月在徐州市第一人民医院接受25G微创玻璃体手术的PCV合并玻璃体积血患者36例36眼的临床资料,依据治疗方式将患者分为2个组,其中扁平部玻璃体切割手术(PPV)组24眼,仅予以PPV治疗;PPV+抗VEGF组12眼,先行PPV并于术后1周行抗VEGF药物玻璃体腔注射。所有患者至少随访6个月,观察并比较2个组患者治疗前、治疗后1个月及末次随访时的最佳矫正视力(BCVA)和黄斑中心凹视网膜厚度(CRT),观察玻璃体再出血和黄斑区瘢痕形成等术后并发症发生情况。结果2个组术眼治疗前后BCVA总体比较差异有统计学意义(F组别=8.552,P=0.006;F时间=31.775,P<0.001),其中2个组术后1个月及末次随访时术眼BCVA均较治疗前明显改善,末次随访时BCVA显著优于术后1个月,差异均有统计学意义(均P<0.05)。PPV+抗VEGF组术后1个月及末次随访时术眼BCVA均优于相应时间点PPV组,差异均有统计学意义(均P<0.05)。2个组术眼治疗前后CRT总体比较差异有统计学意义(F组别=4.797,P=0.041;F时间=295.764,P<0.001),其中2个组术后1个月及末次随访时术眼CRT均较治疗前明显降低,末次随访时CRT明显低于术后1个月,差异均有统计学意义(均P<0.05)。术后1个月时PPV+抗VEGF组术眼CRT低于PPV组,差异有统计学意义(P<0.05);末次随访时2个组间术眼CRT比较差异无统计学意义(P>0.05)。PPV组发生眼压升高2眼,孔源性视网膜脱离1眼,发生率分别为8.33%和4.17%。PPV+抗VEGF组发生白内障加重2眼。PPV组和PPV+抗VEGF组玻璃体再出血发生率分别为16.67%(4/24)和8.33%(1/12),二者比较差异无统计学意义(P=0.646)。PPV组和PPV+抗VEGF组黄斑区瘢痕形成率分别为4.17%(1/24)和33.3%(4/12),差异有统计学意义(P=0.030)。结论微Objective To compare the clinical effects of minimally invasive vitreous surgery with and without anti-vascular endothelial growth factor(VEGF)drugs for polypoid choroidal vascular disease(PCV)complicated with vitreous hemorrhage.Methods A cohort study was performed.Thirty-six consecutive cases(36 eyes)with PCV combined with vitreous hemorrhage who underwent 25G minimally invasive vitreous surgery in Xuzhou First People's Hospital from June 2015 to June 2020 were enrolled.According to surgical methods,the patients were divided into pars plana vitrectomy(PPV)group(24 eyes)receiving vitrectomy only and PPV+anti-VEGF group(12 eyes)receiving vitrectomy first and intravitreal injection of anti-VEGF drugs one week after the operation.All patients were followed up for at least 6 months.The best corrected visual acuity(BCVA)and central retinal thickness(CRT)of the two groups before treatment,1 month after treatment and at the last follow-up were measured and compared.Postoperative complications such as recurrence of vitreous hemorrhage and macular scar formation were recorded.This study followed the Declaration of Helsinki and was reviewed and approved by the Medical Ethics Committee of Xuzhou First People's Hospital(No.xyyll[2021]014).Written informed consent was obtained from each patient before surgery.Results Statistically significant differences were found in BCVA between the two groups before and after treatment(F group=8.552,P=0.006;F time=31.775,P<0.001).The BCVA of the two groups at 1 month after operation and at the last follow-up were significantly improved in comparison with before treatment,and the BCVA at the last follow-up was significantly better than that at 1 month after operation(all at P<0.05).One month after operation and at the last follow-up,the BCVA of PPV+anti-VEGF group was better than that of PPV group,showing statistically significant differences(both at P<0.05).Statistically significant differences were found in CRT between the two groups before and after treatment(F group=4.797,P=0.041;F tim

关 键 词：微创玻璃体手术 息肉样脉络膜血管病变 玻璃体积血 抗VEGF药物治疗 

分 类 号：R779.6[医药卫生—眼科]