难治性糖尿病性黄斑水肿不同治疗方法的临床效果  

Clinical efficacy of different treatment for refractory diabetic macular edema

作　　者：徐小莹 王炯[1] 钱诚[1] 万光明[1] Xu Xiaoying;Wang Jiong;Qian Cheng;Wan Guangming(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

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》2022年第7期513-518,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省医学科技攻关计划省部共建项目(SB201901031)。

摘　　要：目的比较玻璃体内注射阿柏西普、地塞米松植入剂及玻璃体切除术(PPV)联合内界膜剥除术(ILMP)三种方法治疗难治性糖尿病性黄斑水肿(DME)的临床效果。方法回顾性病例对照研究。分析郑州大学第一附属医院2018年8月至2021年8月难治性DME 98例(120眼)的临床资料。根据治疗方式分为3组:A组34例(50眼)行玻璃体内阿柏西普注射,B组27例(30眼)行玻璃体内地塞米松植入剂注射,C组37例(40眼)行PPV联合ILMP。随访期为6个月。观察比较各组患者治疗前后视力、眼压和黄斑中心区视网膜厚度(CMT)。结果治疗后1个月:A、B组视力均有明显提高(t=11.90、9.23,均P<0.001),C组视力无明显改变(t=1.68,P=0.095);3组CMT均有明显下降(t=4.84、5.79、9.83,均P<0.001)。治疗后6个月:A、C组视力较治疗前有明显提高(t=12.25、11.19,均P<0.001),B组无明显变化(t=1.07,P=0.287);3组CMT均较治疗前明显下降(t=5.89、2.81、10.18,均P<0.05)。结论玻璃体内阿柏西普注射、地塞米松植入剂注射及PPV联合ILMP三种方法治疗难治性DME均能降低CMT;玻璃体内注射药物可在短期内提高视力但需反复治疗。Objective To compare the clinical efficacy of three methods:intravitreal injection of Aflibercept,intravitreal injection of Dexamethasone implant and pars plana vitrectomy(PPV)combined with internal limiting membrane peeling(ILMP)for refractory diabetic macular edema(DME).Methods This was a retrospective case control study.Clinical data of 120 eyes of 98 patients with refractory DME from Aug.2018 to Aug.2021 in the First Affiliated Hospital of Zhengzhou University were analyzed.Based on the treatment method,the patients were divided into three groups.In the group A,50 eyes of 34 patients received intravitreal injection of Aflibercept.In the group B,30 eyes of 27 patients received intravitreal injection of Dexamethasone implant.In the group C,40 eyes of 37 patients received PPV combined with ILMP.The follow-up period was 6 months.The visual acuity,intraocular pressure(IOP)and central macular thickness(CMT)before and after treatment were observed and compared among 3 groups.Results At 1 month after treatment,the visual acuity(BCVA)significantly improved in the group A and group B(t=11.90,9.23;all P<0.001),and unchanged in the group C(t=1.68,P=0.095).CMT in all three groups decreased significantly(t=4.84,5.79,9.83;all P<0.001).At 6 months after treatment,the visual acuity of group A and group C significantly improved compared with that before treatment(t=12.25,11.19;all P<0.001),while that of group B did not improve significantly compared with before treatment(t=1.07,P=0.287).CMT in all three groups decreased significantly compared with before treatment(t=5.89,2.81,10.18;all P<0.05).Conclusion Intravitreal injection of Aflibercept,intravitreal injection of Dexamethasone implant and PPV combined with ILMP can effectively reduce the CMT for refractory DME.The intravitreal injection of drug can improve vision in the short term but require repeated treatment.

关 键 词：水肿 黄斑 糖尿病性 难治性 注射 玻璃体内 阿柏西普 注射 玻璃体内 地塞米松植入剂 玻璃体切除术 剥除 内界膜 

分 类 号：R587.2[医药卫生—内分泌] R774.5[医药卫生—内科学]