抗VEGF联合靶向视网膜光凝术对糖尿病性黄斑水肿的临床疗效  

Clinical Effect of Anti-VEGF Combined with Targeted Retinal Photocoagulation in Diabetic Macular Edema

作　　者：桑英旗 张富程 张睿 季芯羽 卢奕安 冷瀛[1] SANG Yingqi;ZHANG Fucheng;ZHANG Rui;JI Xinyu;LU Yi’an;LENG Ying(Affiliated Hospital of Beihua University,Jilin 132011,China;Changchun Purui Eye Hospital,Changchun 130021,China)

机构地区：[1]北华大学附属医院,吉林吉林132011 [2]长春市普瑞眼科医院,吉林长春130021

出　　处：《北华大学学报(自然科学版)》2025年第3期340-344,共5页Journal of Beihua University(Natural Science)

基　　金：吉林省教育厅科学技术研究项目(JJKH20240095KJ);吉林省自然科学基金项目(20200201495JC)。

摘　　要：目的评估抗VEGF(血管内皮生长因子)眼内注射联合靶向视网膜光凝术(TRP)治疗糖尿病性黄斑水肿(DME)的疗效。方法选取重度NPDR/轻度PDR(Ⅲ、Ⅳ期)合并黄斑水肿(DME)患者60例(60眼),根据入组顺序将患者随机分为A组和B组,A组30例(30眼),B组30例(30眼)。A组患者注射康柏西普注射液0.05 mg,1次/月,眼内注射,连续3个月后按需注射;B组患者注射康柏西普注射液0.05 mg,1次/月,眼内注射,连续3个月后按需注射,第1次注射后联合TRP治疗。应用视力检查、光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)观察治疗前,治疗后第1、3、6个月最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)变化;应用酶联免疫吸附法(ELISA)测定治疗前,治疗后第3、6个月患者血清中VEGF水平。结果与治疗前比较,治疗后第1、3、6个月两组患者的最佳矫正视力(BCVA)均有所提升,视网膜CMT有所下降(均P<0.05)。与A组比较,B组患者BCVA明显提高,CMT明显下降(均P<0.05)。与治疗前比较,治疗后第3、6个月两组患者外周血中VEGF水平显著降低(P<0.05)。与A组比较,B组VEGF水平明显降低(P<0.05)。A组注射次数为(4.57±1.01)次,B组总注射次数为(4.03±0.85)次,与A组比较,B组注射次数减少(P<0.05)。随访期间,A组有2例患者进展到增殖期,B组患者均未进展到增殖期。结论抗VEGF治疗联合TRP能有效改善DME患者视力,延缓DR的进展,降低抗VEGF的注射需求,对合并视网膜新生血管或依从性差的DME患者可考虑联合TRP治疗。Objective To evaluate the efficacy of anti-VEGF(vascular endothelial growth factor)intraocular injections combined with targeted retinal photocoagulation(TRP)in the treatment of diabetic macular edema(DME).Methods Sixty patients(60 eyes)with severe NPDR/mild PDR(stagesⅢandⅣ)complicated with diabetic macular edema(DME)were selected and randomly divided into group A and group B according to the order of enrollment.Group A had 30 patients(30 eyes)and group B had 30 patients(30 eyes).Group A patients received 0.05 mg of Conbercept injection once a month via intraocular injection,followed by on-demand injection after 3 consecutive months.Group B patients received 0.05 mg of Conbercept injection once a month via intraocular injection,followed by on-demand injection after 3 consecutive months,and in combination with TRP after the 1st injection.Visual acuity examination,optical coherence tomography(OCT),and fluorescein fundus angiography(FFA)were used to observe changes in best corrected visual acuity(BCVA)and central macular thickness(CMT)before treatment and at 1,3 and 6 months after treatment.Enzyme linked immunosorbent assay(ELISA)was used to measure changes in VEGF levels in the serum of patients before treatment and at 3 and 6 months after treatment.Results At 1,3 and 6 months after treatment,compared with before treatment,both groups of patients showed an improvement in best corrected visual acuity(BCVA)and a decrease in retinal CMT(both P<0.05).Compared with group A,patients in group B showed a significant increase in BCVA and a significant decrease in CMT(both P<0.05).At 3 and 6 months after treatment,compared with before treatment,the levels of VEGF in peripheral blood of both groups of patients were significantly reduced(P<0.05).Com pared with group A,group B showed a significant decrease in VEGF levels(P<0.05).The total number of injections in group A was(4.57±1.01),while the total number of injections in group B was(4.03±0.85).Compared with group A,the number of injections in group B was significantly

关 键 词：靶向视网膜光凝术 抗VEGF 糖尿病性黄斑水肿 

分 类 号：R774.1[医药卫生—眼科]