超声乳化白内障吸除联合玻璃体内注药术治疗白内障伴发糖尿病黄斑水肿  

Phacoemulsification combined with intravitreal injection of VEGF in the treatment of cataract accompanied with diabetic macular edema

作　　者：黄侠[1] 袁军[1] 杨柯 赵宏[1] Huang Xia;Yuan Jun;Yang Ke;Zhao Hong(Department of Ophthalmology,Zhengzhou Municipal Second People’s Hosptial,Zhengzhou 450006,China)

机构地区：[1]郑州市第二人民医院眼科,郑州450006

出　　处：《中华眼外伤职业眼病杂志》2024年第2期135-140,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联合共建项目(LHGJ20200711)。

摘　　要：目的评价超声乳化白内障吸除术联合玻璃体内注射抗血管内皮生长因子(VEGF)药物治疗白内障伴发糖尿病黄斑水肿的有效性及安全性。方法前瞻性随机对照研究。将郑州市第二人民医院2020年7月至2023年7月住院治疗的白内障伴发糖尿病黄斑水肿51例(51眼)按随机数字表法分为两组。观察组26例(26眼),采取超声乳化白内障吸除联合人工晶状体植入术,同期联合玻璃体内注射雷珠单抗;对照组25例(25眼),单纯行玻璃体内注射抗雷珠单抗治疗。观察两组术后1及3个月的裸眼视力、最佳矫正视力(BCVA,logMAR)、眼压、黄斑中心区视网膜厚度(CMT)、眼轴长度(AL),以及眼部炎症反应、有无玻璃体积血或视网膜脱离等并发症。术后随访3个月。结果两组术后1及3个月视力(BCVA)对比,观察组(0.55±0.24、0.61±0.26)均优于对照组(0.77±0.25、0.81±0.25),差异有统计学意义(t=-3.26、-2.91,P=0.002、0.006);CMT观察组与对照组术后1个月[(298.31±32.09)μm vs(297.00±16.26)μm,t=0.98,P=0.359]及术后3个月[(318.11±31.29)μm vs(312.32±31.11)μm,t=0.65,P=0.516]对比差异无统计学意义。AL观察组与对照组术后1个月[(23.36±0.77)mm vs(23.29±0.60)mm,t=0.32,P=0.754]及术后3个月[(23.45±0.79)mm vs(23.33±0.59)mm,t=0.58,P=0.568]对比差异无统计学意义。观察组术后1个月、3个月实际屈光度数(-0.26±0.05,-0.26±0.04)D与术前目标屈光度数(-0.26±0.06)D对比差异无统计学意义(F=0.05,P=0.954)。观察组术后2 h内一过性眼压升高2眼,对照组3眼。两组均无玻璃体积血、视网膜脱离或眼内炎等其他并发症发生。结论超声乳化联合同期玻璃体内注射抗VEGF药物手术能够在治疗白内障的同时,有效减轻糖尿病性黄斑水肿,尽早改善视力,且人工晶状体植入度数误差小,并发症少。Objective To evaluate the efficacy and safety of phacoemulsification combined with intravitreal injection of anti-vascular endothelial growth factor(VEGF)in the treatment of cataract accompanied with diabetic macular edema.Methods This was a prospective randomized controlled study.Fifty-one cases(51 eyes)of cataract accompanied with diabetic macular edema who were hospitalized in Zhengzhou Municipal Second People′s Hosptial from Jul.2020 to Jul.2023 were divided into two groups,based on random number table methods.In the observation group,26 cases(26 eyes)accepted phacoemulsification and intraocular lens implantation,combined with intravitreal injection of ranibizumab.In the control group,25 patients(25 eyes)accepted intravitreal injection of ranibizumab.The main outcome measures included the visual acuity,best corrected visual acuity(BCVA,logMAR),intraocular pressure,central macular thickness(CMT),axial length(AL),as well as eye inflammation,vitreous hemorrhage,or retinal detachment in both groups at 1 and 3 months after surgery.The patients were followed up for 3 months.Results BCVA at 1 and 3 months after surgery was better in the observation group(0.55±0.24,0.61±0.26)than that in the control group(0.77±0.25,0.81±0.25),and the differences were statistically significant(t=-3.26,-2.91;P=0.002,0.006).There was no significant difference in CMT between the observation group and the control group at 1 month after surgery[(298.31±32.09)μm vs(297.00±16.26)μm,t=0.98,P=0.359]and at 3 months after surgery[(318.11±31.29)μm vs(312.32±31.11)μm,t=0.65,P=0.516].There was no significant difference in AL between the observation group and the control group at 1 month after surgery[(23.36±0.77)mm vs(23.29±0.60)mm,t=0.32,P=0.754]and at 3 month after surgery[(23.45±0.79)mm vs(23.33±0.59)mm,t=0.58,P=0.568].In the observation group,the preoperative target diopter(-0.26±0.06)D was compared with the actual diopter 1 month and 3 months after surgery(-0.26±0.05,-0.26±0.04)D,there was no statistically significant diff

关 键 词：超声乳化术 注药术 玻璃体内 白内障 水肿 黄斑 糖尿病性 药物 VEGF 抗 

分 类 号：R779.6[医药卫生—眼科] R587.2[医药卫生—临床医学]