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.

参考文献

[1] 陈红娟,陈建英,李琳. 两种术式治疗糖尿病视网膜病变合并白内障疗效比较[J].山东医药,2010,50(5):69-70. doi:10.3969/j.issn.1002-266X.2010.05.033. CHEN Hongjuan, CHEN Jianying, LI Lin. Comparison of two methods in the treatment of diabetic retinopathy with cataract[J]. Shandong Med J, 2010, 50(5):69-70. doi:10.3969/j.issn.1002-266X.2010.05.033.
[2] 张岩,马军艳,王翠,等. 玻璃体腔注射曲安奈德对糖尿病性视网膜病变患者超声乳化白内障吸除术后黄斑厚度的影响[J]. 中华眼科医学杂志,2015,5(6): 24-29.doi:10.3877/cma.j.issn.2095-2007.2015.06.004. ZHANG Yan, MA Junyan, WANG Cui, et al. Effect of intravitreal triamcinolone acetonide injection on macular thickness in diabetic retinopathy patients having phacoemulsification[J]. Chin J Ophthalmol Med, 2015, 5(6):24-29. doi:10.3877/cma.j.issn.2095-2007.2015.06.004.
[3] 许迅,郑颖. 重视对糖尿病黄斑水肿的治疗[J].中华眼底病杂志,2016,32(2):119-121. doi:10.3760/cma.j.issn.1005-1015.2016.02.002. XU Xun, ZHENG Ying. Focusing on the treatment of diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2016, 32(2):119-121. doi:10.3760/cma.j.issn.1005-1015.2016.02.002.
[4] 林为华,卢敏,唐浩英,等. 雷珠单抗在糖尿病性白内障治疗中的临床应用[J].国际眼科杂志,2015,15(5):880-882. doi:10.3980/j.issn.1672-5123.2015.5.37 LIN Weihua, LU Min, TANG Haoying, et al. Clinical application of Ranibizumab in the therapy of diabetic cataract[J]. Int J Ophthalmol, 2015, 15(5):880-882. doi:10.3980/j.issn.1672-5123.2015.5.37
[5] 程明智,王翠,陈明. 超声乳化联合玻璃体内注射雷珠单抗治疗糖尿病性白内障的临床观察[J].眼科新进展,2016,36(8):754-756. doi:10.13389/j.cnki.rao.2016.0201. CHENG Mingzhi, WANG Cui, CHEN Ming. Phacoemulsification combined with intravitreal injection of lucentis for diabetic cataract[J]. Rec Adv Ophthalmol, 2014, 30(2):141-144. doi:10.13389/j.cnki.rao.2016.0201.
[6] 戴昳宁,郑霖,戴荣平,等. 白内障超声乳化手术中联合玻璃体腔注射曲安奈德治疗糖尿病性黄斑水肿合并重度白内障的疗效观察[J].中华眼底病杂志,2014,30(2):141-144. doi:10.3760/cma.j.issn.1005-1015.2014.02.006. DAI Yining, ZHENG Lin, DAI Rongping, et al. Phacoemulsification with intravitreal triamcinolone injection to treat diabetic macular edema with severe cataract[J]. Chin J Ocul Fundus Dis, 2014, 30(2):141-144. doi:10.3760/cma.j.issn.1005-1015.2014.02.006.
[7] Chae JB, Joe SG, Yang SJ, et al. Effect of combined cataract surgery and ranibizumab injection in postoperative macular edema in nonproliferative diabetic retinopathy[J]. Retina(Philadelphia, Pa), 2014, 34(1): 149-156. doi:10.1097/IAE.0b013e3182979b9e.
[8] 邵娜,张晗. 糖尿病患者行白内障超声乳化术后视力及眼底的变化[J].山东大学耳鼻喉眼学报,2016,30(1):83-87. doi:10.6040/j.issn.1673-3770.0.2015.341. SHAO Na, ZHANG Han. Variation of visual acuity and fundus in type 2 diabetic patients after phacoemulsification surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2016, 30(1):83-87. doi:10.6040/j.issn.1673-3770.0.2015.341.
[9] 李弘. 超声乳化白内障术后糖尿病性视网膜和黄斑病变研究进展[J].中国实用眼科杂志,2014,32(5):538-542. doi:10.3760/cma.j.issn.1006-4443.2014.05.003. LI Hong. Research progress of diabetic retinopathy and macular degeneration after phacoemulsification[J].Chin J Pract Ophthalmol, 2014, 32(5):538-542. doi:10.3760/cma.j.issn.1006-4443.2014.05.003.
[10] 杨柳,张婧. 糖尿病性黄斑水肿治疗方法的选择[J].中华眼科杂志,2017,53(10):724-728. doi:10.3760/cma.j.issn.0412-4081.2017.10.002. YANG Liu, ZHANG Jing. Choice of treatment for diabetic macular edema[J]. Chin J Ophthalmol, 2017, 53(10):724-728. doi:10.3760/cma.j.issn.0412-4081.2017.10.002.
[11] 韩月圣,魏文斌. Ranibizumab玻璃体腔注射后糖尿病黄斑水肿患者中心视网膜厚度相对变化与视力预后的关系[J]. 中华实验眼科杂志, 2016,34(1):78-84. doi:10.3760/cma.j.issn.2095-0160.2016.01.017. HAN Yuesheng, WEI Wenbin. The relationship between central retinal thickness relative change and visual prognosis in diabetic macular edema patients following intravitreal injection of ranibizumab[J]. Chin J Exp Ophthalmol, 2016, 34(1):78-84. doi:10.3760/cma.j.issn.2095-0160.2016.01.017.
[12] 杨波, 宋艳. 超声乳化联合曲安奈德玻璃体腔内注射治疗白内障合并糖尿病黄斑水肿[J]. 国际眼科杂志, 2015, 15(9):1532-1535. doi:10.3980/j.issn.1672-5123.2015.9.10 YANG Bo, SONG Yan. Therapeutic effects of phacoemulsification combined with intravitreal injection of triamcinolone in treating cataract with diabetic macular edema[J]. Int J Ophthalmol, 2015, 15(9):1532-1535. doi:10.3980/j.issn.1672-5123.2015.9.10
[13] 唐瑞雪. 玻璃体腔内注射曲安奈德与贝伐单抗治疗白内障术后黄斑水肿的疗效[J]. 国际眼科杂志,2016,16(1):135-137. doi:10.3980/j.issn.1672-5123.2016.1.38. TANG Ruixue. Effect of intravitreal injection of triamcinolone acetonide and bevacizumab for macular edema after cataract surgeries[J]. Int J Ophthalmol, 2016, 16(1):135-137. doi:10.3980/j.issn.1672-5123.2016.1.38.
[14] 吕勇,范琼艳,杨琳,等.老年白内障手术联合玻璃体腔注射雷珠单抗对糖尿病性黄斑水肿影响[J]. 中国实用眼科杂志,2014,32(5):560-563. doi:10.3760/cma.j.issn.1006-4443.2014.05.009. LVE Yong, FAN Qiongyan, YANG Lin, et al. Effect of combined senile diabetic cataract surgery and intravitreal lucentis injection on diabetic macular edema[J]. Chin J Pract Ophthalmol, 2014, 32(5):560-563. doi:10.3760/cma.j.issn.1006-4443.2014.05.009.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

[1]	李梦欣,徐慧,张晓玲,薛晴,纪霜钰,李莹莹,崔丽梅,郭兆剑,宋西成,孙岩,陈良. 糖皮质激素通过下调水通道蛋白2缓解精氨酸加压素诱导的膜迷路积水[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 1-6.
[2]	王新萌,姬俊雅,于浩南,付鸿臣,王翔,郑泽坤,李艳,钟莹莹. 急性闭角型青光眼超声乳化联合房角分离术后屈光预测准确性分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 74-79.
[3]	朱明琼,李征,刘茹,田涛,彭婧利,吕倩怡,谭华霞. 基于OCT/OCTA的AI筛查系统在抗VEGF治疗糖尿病性黄斑水肿患者效果评价中的应用[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 68-73.
[4]	孙庆祝,沈健,陈星,吴雁冰,曾论. 代谢指标在预测糖尿病性黄斑水肿患者雷珠单抗疗效中的作用[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 74-81.
[5]	朱云龙,王平,高萌. 误诊为中浆及视网膜炎的后巩膜炎1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 99-105.
[6]	段思妤,薛金梅. 组蛋白去乙酰化酶2在慢性气道炎症性疾病糖皮质激素抵抗中的研究进展[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 120-126.
[7]	熊琴, 张砚, 乌日娜, 李锋, 唐力行. 鼻用糖皮质激素在儿童中的应用[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 160-167.
[8]	黄旗,邓旭雯,王佩佩,陈烨群,古学军. 基于EyeSi手术模拟器评估眼科医师白内障手术水平[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 83-88.
[9]	丁术梁,王超凡,刘建亮. 眼内液检测指导精准治疗急性视网膜坏死1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 114-117.
[10]	汪盛,黄旭东. 铁死亡与年龄相关性白内障的研究新进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 161-168.
[11]	曹正勇,李小波. 慢性鼻-鼻窦炎合并哮喘术后短程局部使用糖皮质激素辅助治疗的安全性和有效性[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 43-50.
[12]	孙鸿翔,曹娟. 老年白内障患者心理脆弱现状及其与希望水平和述情障碍的相关性[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 89-95.
[13]	王振晓,时光刚,何明强,时蕾. 哮吼患者的治疗选择和管理策略[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 136-144.
[14]	沈嘉琪,李潇飒,毕燕龙,张敬法. 人工智能在DME筛查、诊断和预后中的应用[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 153-159.
[15]	陈兴雪,张广玲,武天义,王卫卫,孙占伟,李世超,王广科. 抗IL-4Rα单克隆抗体与鼻内镜手术治疗嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的疗效分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 43-54.