25+微创玻璃体视网膜手术联合玻璃体腔注射雷珠单抗治疗增生型糖尿病视网膜病变的临床观察

doi:10.6040/j.issn.1673-3770.0.2017.023

摘要/Abstract

摘要： 目的研究25+微创玻璃体视网膜手术(VRS)联合玻璃体腔注射雷珠单抗(IVR)治疗增生型糖尿病视网膜病变(PDR)的效果。方法选取行25+微创VRS患者88例(88眼),分为治疗组(n=44)和对照组(n=44)。治疗组术前3~5 d予以IVR治疗后行25+微创VRS;对照组仅行25+微创VRS。比较两组患者术中情况、最佳矫正视力(BCVA)、眼压及术后并发症情况。结果治疗组患者的手术时间、电凝次数、医源性裂孔发生率、玻璃体腔硅油填充率均低于对照组(P<0.05);术后两组患者BCVA均高于术前(P<0.05),术后两组患者眼压均低于术前(P<0.05);术后3个月,治疗组患者玻璃体积血发生率、牵拉性视网膜脱离发生率均低于对照组(P<0.05)。结论行25+微创VRS联合IVR可有效缩短手术时间,降低医源性裂孔和玻璃体出血发生率,降低硅油填充率,有助于PDR患者术后视力的恢复。

关键词: 视力, 增生型糖尿病视网膜病变, 玻璃体视网膜手术, 雷珠单抗

Abstract: Objective To study the effect of 25-gauge minimally invasive vitreoretinal surgery(VRS)in combination with intravitreal ranibizumab(IVR)injections to treat proliferative diabetic retinopathy(PDR). Methods Eighty-eight PDR patients(88 eyes)who had undergone 25-gauge minimally invasive VRS in our hospital were selected. The patients were divided into a treatment group(n=44)and a control group(n=44)according to the different preoperative treatments they had received. In the treatment group, IVR injections were administered 3 to 5 days prior to the surgery(25-gauge minimally invasive VRS), whereas in the control group, only the 25-gauge minimally invasive VRS was performed. Intraoperative situation, best-corrected visual acuity(BCVA), intraocular pressure, and postoperative complications were compared between the 2 groups, and statistically analyzed. Results In the treatment group, the operation time, frequency of coagulation, incidence of iatrogenic fracture, and the filling rate of silicone oil were all significantly lower in comparison with the control group(P<0.05). The BCVA values of the 2 groups postoperatively were significantly higher than the preoperative values(P<0.05). The intraocular pressure values noted in the 2 groups postoperatively were significantly lower than those observed preoperatively(P<0.05). Three months following the operation, the incidence of vitreous and retinal detachment in the treatment group was significantly lower than that in the control group(P<0.05). Conclusion The treatment of PDR with 25-gauge minimally invasive VRS in combination with IVR injections can effectively shorten the operation time, reduce the incidence of iatrogenic fracture and vitreous hemorrhage, decrease the rate of silicone oil filling, and aid in the recovery of visual acuity.

Key words: Proliferative diabetic retinopathy, Ranibizumab, Visual acuity, Vitreoretinal surgery

中图分类号:

R779.6

周学义,李一鸣,王美菊,张苑苑,张历浊. 25+微创玻璃体视网膜手术联合玻璃体腔注射雷珠单抗治疗增生型糖尿病视网膜病变的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 87-89.

ZHOU Xueyi, LI Yiming, WANG Meiju, ZHANG Yuanyuan, ZHANG Lizhuo. The application of 25-gauge minimally invasive vitreoretinal surgery combined with intravitreal ranibizumab injections in the treatment of proliferative diabetic retinopathy.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(4): 87-89.

参考文献

[1] 张扬, 戴荣平, 卞爱玲. 玻璃体腔注射雷珠单抗对增殖性糖尿病视网膜病变手术的影响[J]. 国际眼科杂志, 2015, 15(8):1450-1454. ZHANG Yang, DAI Rongping, BIAN Ailing. Effect of ranibizumab intravitreal injection as an adjunct before vitrectomy surgery in the treatment of patients with proliferative diabetic retinopathy[J]. Int Eye Sci, 2015, 15(8):1450-1454.
[2] 孙梅, 李明新. 糖尿病视网膜病变围手术期的抗VEGF研究[J]. 国际眼科杂志, 2015, 15(10):1772-1774. SUN Mei, LI Mingxin. Study of anti-vascular endothelial growth factor medicine for proliferative diabetic retinopathy at perioperative period[J]. Int Eye Sci, 2015, 15(10):1772-1774.
[3] 中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11):851-865.
[4] 刘鹤南, 李迅, 濮伟, 等. 手术前玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab预防增生型糖尿病视网膜病变玻璃体切割手术后玻璃体积血的Meta分析[J]. 中华眼底病杂志, 2012, 28(3):281-285. LIU Henan, LI Xun, PU Wei, et al. Intravitreal bevacizumab as a preoperative adjunct to vitrectomy for prevention of postoperative vitreous hemorrhage in proliferative diabetic retinopathy:a meta-analysis[J]. Chin J Ocul Fundus Dis, 2012, 28(3):281-285.
[5] Holm K, Schroeder M, Lovestam Adrian M. Peripheral retinal function assessed with 30-Hz flicker seems to improve after treatment with Lucentis in patients with diabetic macular oedema[J]. Doc Ophthalmol, 2015, 131(1):43-51.
[6] 朱丽, 陈晓, 宋艳萍, 等. 玻璃体腔注射雷珠单抗联合25G+玻璃体视网膜手术治疗增生型糖尿病视网膜病变的临床观察[J]. 中华眼底病杂志, 2016, 32(1):22-25. ZHU Li, CHEN Xiao, SONG Yanping, et al. The effect of intravitreal injection of ranibizumab combined with vitrectomy to treat proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(1):22-25.
[7] 赵新荣, 杨炜, 邱明磊, 等. 玻璃体内注射雷珠单抗联合玻璃体切割术治疗严重增生型糖尿病视网膜病变[J]. 眼科新进展, 2015, 35(11):1064-1066.

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