玻璃体腔注射雷珠单抗联合577 nm阈值下微脉冲激光光凝治疗糖尿病性黄斑水肿的临床疗效及安全性  

Clinical Efficacy and Safety Evaluation of Intravitreal Injection of Ranibizumab Combined with 577 nm Subthreshold Micropulse Laser in Treatment of Diabetic Macular Edema

作　　者：陈娟[1] 章静 王明伟[2] CHEN Juan;ZHANG Jing;WANG Mingwei(Department of Ophthalmology,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Cardiology,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院眼科,杭州310015 [2]杭州师范大学附属医院心内科,杭州310015

出　　处：《医学综述》2022年第21期4343-4347,共5页Medical Recapitulate

基　　金：杭州市科技发展计划项目(20191203B105)。

摘　　要：目的评估玻璃体腔注射雷珠单抗联合577 nm阈值下微脉冲激光光凝(SMLP)治疗糖尿病性黄斑水肿(DME)的临床疗效及安全性。方法回顾性分析2018年1月至2020年3月杭州师范大学附属医院眼科收治的32例(43眼)DME患者的临床资料,依据治疗方法不同分为联合组16例(23眼)和药物组16例(20眼)。所有患者均进行雷珠单抗注射(每月1次、连续3个月)以及全视网膜光凝治疗,联合组在首次雷珠单抗治疗后2~4周内进行577 nm SMLP治疗,观察时间≥12个月。比较两组术前和术后1、3、6、9和12个月最佳矫正视力(BCVA)、中央黄斑厚度(CMT)和黄斑总体积(TMV),随访前6个月和后6个月雷珠单抗注射次数,并记录不良反应发生情况。结果BCVA、CMT和TMV手术前后的主效应差异有统计学意义(P<0.01),BCVA组间的主效应差异有统计学意义(P<0.05);两组术后各时点BCVA均高于术前(P<0.01),CMT和TMV均低于术前(P<0.01),术后3个月BCVA、CMT和TMV均低于术后1个月(P<0.01),两组术后6、9、12个月的BCVA、CMT和TMV比较差异均无统计学意义(P>0.05)。术后随访后6个月,联合组雷珠单抗注射次数少于药物组[(1.57±0.15)次比(3.15±0.18)次](P<0.01)。两组术中及术后随访均未出现眼内出血、感染、视网膜脱离、晶体损伤等并发症。结论玻璃体腔注射雷珠单抗联合577 nm SMLP治疗DME在治疗后期能减少雷珠单抗注射次数,雷珠单抗是否联合微脉冲激光光凝均能有效提高BCVA,减轻CMT和TMV。Objective To evaluate the clinical efficacy and safety of vitreous injection of ralizumab combined with subthreshold micropulse laser photocoagulation(SMLP)at 577 nm for diabetic macular edema(DME).Methods Clinical data of 32 patients(43 eyes)of DME treated in Affiliated Hospital of Hangzhou Normal University from Jan.2018 to Mar.2020 were retrospectively analyzed.The patients were divided into a combination group(16 cases,23 eyes)and a drug group(16 cases,20 eyes)according to different treatment methods.All the patients received ralizumab injection(once a month for 3 consecutive months)and total retinal photocoagulation,and the combination group received 577 nm SMLP within 2-4 weeks after the first ralizumab treatment,the observation time≥12 months.The best corrected visual acuity(BCVA),central macular thickness(CMT)and total macular volume(TMV)were compared between the two groups before and 1,3,6,9 and 12 months after surgery.The number of ralizumab injections in the first 6 months and the second 6 months were followed up,and the incidence of adverse reactions was recorded.Results There were statistically significant differences in the main effects of BCVA,CMT and TMV before and after surgery(P<0.01),and there were statistically significant differences in the main effects of BCVA between groups(P<0.05).BCVA in both groups at each time point after surgery were higher than those before surgery(P<0.01),while CMT and TMV were lower than those before surgery(P<0.01).BCVA,CMT and TMV at 3 months after surgery were lower than those at 1 month after surgery(P<0.01).There were no significant differences in BCVA,CMT and TMV between the two groups at 6,9 and 12 months after surgery(P>0.05).6 months after the postoperative follow-up,the frequency of ralizumab injection in the combination group was less than that in the drug group[(1.57±0.15)times vs(3.15±0.18)times](P<0.01).There were no intraocular bleeding,infection,retinal detachment,crystal damage and other complications in both groups during operation and postoper

关 键 词：糖尿病性黄斑水肿 糖尿病视网膜病变 微脉冲 激光凝固术 抗血管内皮生长因子 

分 类 号：R774.5[医药卫生—眼科]