术前玻璃体腔注射雷珠单抗对PDR患者视网膜手术的影响-现代医学

术前玻璃体腔注射雷珠单抗对PDR患者视网膜手术的影响

单位：北京市民众眼科医院眼科, 北京 100192

分类号：R779.6

出版年·卷·期（页码）：2017·36·第五期（689-692）

摘要：

目的：探讨术前玻璃体腔注射雷珠单抗（IVR）对增生型糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）患者25G微创玻璃体视网膜手术（VRS）操作及术后视力的影响。方法：对行25G微创VRS治疗的80例PDR患者（90只眼）的临床资料进行回顾性分析，按照术前是否IVR注射将患者分为观察组和对照组。观察组（39例44只眼）术前IVR注射后再行25G微创VRS；对照组（41例46只眼）单纯行25G微创VRS。术后随访6～18个月，比较两组手术相关参数及术后视力情况。结果：与对照组相比，观察组手术时间明显缩短（t=7.071，P<0.001），眼内电凝止血次数减少（t=2.395，P=0.019），患眼医源性视网膜裂孔发生率（χ²=5.394，P=0.020）、玻璃体再积血发生率（χ²=6.429，P=0.011）、玻璃体腔硅油填充率（χ²=7.474，P=0.006）均较低。术后6个月，两组患眼的最小视角对数视力表最佳矫正视力（logMAR BCVA）比较，差异无统计学意义，但较术前的logMAR BCVA均明显升高。结论：PDR患者患眼术前IVR注射可明显缩短25G微创VRS的手术时间，降低玻璃体腔硅油填充率，减少术中出血、医源性视网膜裂孔及玻璃体再积血的发生率，对术后视力无影响。

Objective: To investigate the effect of preperative intravitreal ranibizumab(IVR) on vitrectomy and postoperative visual acuity in treatment of proliferative diabetic retinopathy(PDR). Methods: A retrospective analysis was performed on 90 eyes of 80 patients with PDR treated by 25G minimally invasive VRS. Patients were divided into observation group and control group according to the preoperative intravitreal injection of IVR. Observation group(39 cases,44 eyes) were treated with minimally invasive VRS (25G) after IVR injection, while the control group(41 cases, 46 eyes) were treated with minimally invasive VRS (25G)only.Postoperative follow up for 6 to 18 months, the operation process and postoperative visual acuity of the two groups were compared.Results: Compared with the control group, the operation time was significantly shorter (t=7.071,P<0.001),ntraocular electrocoagulation was decreased (t=2.395,P=0.019)in the observation group,the incidence rate of iatrogenic retinal hole (χ²=5.394,P=0.020), vitreous hemorrhage(χ²=6.429,P=0.011) and the fill rate of silicone oil (χ²=7.474,P=0.006) were lower. Six months after operation, there was no significant difference in logMAR BCVA between the two groups,but the logMAR BCVA was significantly higher than that before operation. Conclusion: Preoperative intravitrealIVR injection in the patients with PDR can obviously shorten the operation time of 25G minimally invasive VRS, reduce the fill rate of silicone oil and intraoperative bleeding, the incidence of iatrogenic retinal and vitreous body hematocele.It does not affect the postoperative visual acuity.

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