超声乳化联合玻璃体腔药物注射治疗白内障合并糖尿病性黄斑水肿

doi:10.6040/j.issn.1673-3770.0.2018.337

摘要/Abstract

摘要： 目的探讨合并糖尿病性黄斑水肿(DME)的白内障患者行超声乳化联合玻璃体腔药物注射的治疗效果和安全性。方法将66例(78眼)白内障合并DME患者,随机分为3组,对照组单纯行白内障超声乳化吸除联合人工晶体植入术,雷珠单抗玻璃体腔注射组(IVR组)行白内障手术联合雷珠单抗玻璃体腔注射,曲安奈德玻璃体腔注射组(IVTA组)行白内障手术联合曲安奈德玻璃体腔注射。比较3组患者术前及术后1周、1个月、3个月和6个月最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CRT)及眼压等指标的差异。结果 3组患者性别、年龄、糖尿病(DM)病程、术前BCVA(LogMAR)、CRT和眼压等基线资料的差异无统计学意义(P均>0.05)。术前、术后3组的BCVA(LogMAR)、CRT随时间变化的整体趋势(time)差异有统计学意义(P<0.05), 3组之间BCVA(LogMAR)、CRT随时间变化的趋势差异(time*group)有统计学意义(P<0.05),不考虑时间因素,3组BCVA(LogMAR)、CRT的综合差异(group)也有统计学意义(P<0.05);3组之间BCVA(LogMAR)、CRT的比较:IVR组与对照组差异,IVTA组与对照组差异均有统计学意义(P<0.05),IVR组与IVTA组的差异均无统计学意义(P>0.05)。3组的眼压随时间变化的整体趋势(time)有统计学意义(P<0.001), 3组之间眼压随时间变化的趋势差异(time*group)有统计学意义(P<0.001),术后1周、1个月IVTA组眼压升高,与对照组、IVR组眼压差异有统计学意义(P均<0.05)。不考虑时间因素,3组眼压的综合差异无统计学意义(P=0.249)。结论对合并DME的白内障患者在超声乳化手术中联合玻璃体腔注射雷珠单抗或曲安奈德均可提高患者的最佳矫正视力,减轻黄斑水肿,雷珠单抗不会引起眼压升高,较曲安奈德安全性更高。

关键词: 白内障, 糖尿病视网膜病变/并发症, 黄斑水肿, 人源化单克隆抗体, 糖皮质激素

Abstract: Objective To investigate the efficacy and safety of phacoemulsification combined with intravitreal ranibizumab or triamcinolone acetonide injection for treating patients with cataract accompanied by diabetic macular edema(DME). Methods In this case-control study, 66 patients(78 eyes)with cataract complicated by DME were randomly divided into three groups. The control group was treated with phacoemulsification and intraocular lens implantation. The IVR group was treated with cataract surgery and intravitreal ranibizumab injection. The IVTA group was treated with cataract surgery and intravitreal triamcinolone acetonide injection. The differences in best corrected visual acuity(BCVA), macular center retinal thickness(CRT), and intraocular pressure were compared among the three groups preoperatively and 1 week, 1 month, 3 months, and 6 months postoperatively. Results There were no significant differences in sex, age, duration of DM, preoperative BCVA(LogMAR), CRT, and intraocular pressure among the three groups(P>0.05). The overall trend(time)of BCVA(LogMAR)and CRT changes with time in the three groups before and after operation was significant(P<0.05). The trend(time*group)of BCVA(LogMAR)and CRT changes over time among the three groups was significant. The comprehensive differences(group)in BCVA(LogMAR)and CRT among the three groups were also significant regardless of time(P<0.05). Comparison of BCVA(LogMAR)and CRT among the three groups revealed a significant difference between the IVR group and control group, and between the IVTA group and control group(P<0.05). In addition, there was no significant difference between the IVR and IVTA groups in BCVA(LogMAR)and CRT(P>0.05). The overall trend(time)of intraocular pressure changes with time in the three groups was significant(P<0.001). The trend(time*group)of intraocular pressure changes over time among the three groups was significant(P<0.001). In 1 week and 1 month after operation, the intraocular pressure of the IVTA group increased, and there was significant difference between the IVTA group and the control group, and between the IVTA group and the IVR group(P<0.05). The comprehensive difference(group)in intraocular pressure among the three groups was not significant regardless of time(P=0.249). Conclusion Phacoemulsification combined with intravitreal ranibizumab or triamcinolone acetonide injection can improve BCVA and reduce macular edema in patients with cataract accompanied by DME. In addition, ranibizumab does not cause an increase in intraocular pressure and is safer and more reliable than triamcinolone acetonide.

Key words: Cataract, Diabetic retinopathy/complications, Macular edema, Antibodies, monoclonal, humanized, Glucocorticoids

中图分类号:

R774.1

刘建波,张环. 超声乳化联合玻璃体腔药物注射治疗白内障合并糖尿病性黄斑水肿[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 99-104.

LIU Jianbo, ZHANG Huan. Phacoemulsification combined with intravitreal ranibizumab or triamcinolone acetonide injection for the treatment of cataract accompanied by diabetic macular edema[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 99-104.

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