玻璃体切除术联合雷珠单抗玻璃体注射治疗增殖性糖尿病视网膜病变的临床研究
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摘要
目的探讨玻璃体切除术(PPV)联合雷珠单抗玻璃体注射治疗增殖性糖尿病视网膜病变(PDR)的临床疗效。方法选择2014年1月至2017年12月西安市第四医院眼科收治的68例PDR患者为研究对象,按照随机数表法分为观察组和对照组,每组34例,观察组给予PPV联合雷珠单抗玻璃体注射治疗,对照组单纯给予PPV治疗,比较两组患者术后视力改善情况、手术时间、眼内压、黄斑中心凹视网膜和并发症情况。结果观察组患者的术后视力改善率为70.6%,明显高于对照组的41.2%,差异具有统计学意义(P<0.05);观察组患者手术时间为(55.7±11.6) min,明显短于对照组的(92.4±13.5) min,黄斑中心凹视网膜厚度为(289.3±20.1)μm,明显低于对照组(331.5±22.4)μm,差异均有统计学意义(P<0.05);观察组和对照组患者术后眼压[(17.4±3.3) mm Hg vs (18.7±3.5) mm Hg]比较差异无统计学意义(P>0.05);并发症主要为无菌性眼炎、术后再出血、术后感染和再增殖,观察组患者术后并发症的发生率为17.6%(6/34),明显低于对照组的55.9%(19/34),差异有统计学意义(P<0.05)。结论 PPV联合雷珠单抗玻璃体注射治疗PDR可以有效改善患者视力,减少术后并发症发生率,临床疗效显著,值得推广应用。
Objective To explore the effect of pars plana vitrectomy combined with intravitreal injection of lucentis in the treatment of proliferative diabetic retinopathy(PDR). Methods A total of 68 patients with proliferative diabetic retinopathy(PDR) from Department of Ophthalmology, Xi'an Fourth Hospital from January 2014 to December2017 were randomly divided into the observation group(n=34) and the control group(n=34) according to random number table. Patients in the observation group were treated with pars plana vitrectomy combined with intravitreal injection of lucentis, while those in the control group were treated with pars plana vitrectomy only. Then the visual acuity improvement, operation time, intraocular pressure, macular foveal retinal thickness, and complications were compared between the two groups. Results The improvement rate of visual acuity was 70.6% in observation group, which was significantly higher than 41.2% in the control group(P<0.05). The operation time and macular fovea retinal thickness were(55.7±11.6) min and(289.3±20.1) μm in the observation group, versus(92.4±13.5) min and(331.5±22.4) μm in the control group(P<0.05). There was no statistically significant difference between the two group in intraocular pressure:(17.4±3.3) mmHg vs(18.7±3.5) mmHg, P>0.05. The main complications included aseptic endophthalmitis, postoperative rebleeding, postoperative infection, and reproliferation. The incidence of complications in the observation group was significantly lower than that of the control group: 17.6%(6/34) vs 55.9%(19/34), P<0.05. Conclusion Pars plana vitrectomy combined with intravitreal injection of lucentis has significant effect in the treatment of PDR, which can significantly improve the vision of patients and results in less postoperative complications.
Objective To explore the effect of pars plana vitrectomy combined with intravitreal injection of lucentis in the treatment of proliferative diabetic retinopathy(PDR). Methods A total of 68 patients with proliferative diabetic retinopathy(PDR) from Department of Ophthalmology, Xi'an Fourth Hospital from January 2014 to December2017 were randomly divided into the observation group(n=34) and the control group(n=34) according to random number table. Patients in the observation group were treated with pars plana vitrectomy combined with intravitreal injection of lucentis, while those in the control group were treated with pars plana vitrectomy only. Then the visual acuity improvement, operation time, intraocular pressure, macular foveal retinal thickness, and complications were compared between the two groups. Results The improvement rate of visual acuity was 70.6% in observation group, which was significantly higher than 41.2% in the control group(P<0.05). The operation time and macular fovea retinal thickness were(55.7±11.6) min and(289.3±20.1) μm in the observation group, versus(92.4±13.5) min and(331.5±22.4) μm in the control group(P<0.05). There was no statistically significant difference between the two group in intraocular pressure:(17.4±3.3) mmHg vs(18.7±3.5) mmHg, P>0.05. The main complications included aseptic endophthalmitis, postoperative rebleeding, postoperative infection, and reproliferation. The incidence of complications in the observation group was significantly lower than that of the control group: 17.6%(6/34) vs 55.9%(19/34), P<0.05. Conclusion Pars plana vitrectomy combined with intravitreal injection of lucentis has significant effect in the treatment of PDR, which can significantly improve the vision of patients and results in less postoperative complications.
引文
[1]邢薇,董志军,张铁民.糖尿病视网膜病变发病机制的研究进展[J].中国实用眼科杂志,2014,32(6):675-678.
[2]王德功,陈松,王昀,等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重增生型糖尿病视网膜病变的临床观察[J].中华眼底病杂志,2014,30(2):136-140.
[3]付浴东,王萍,江莉,等.玻璃体腔注射雷珠单抗,全视网膜激光光凝对增生型糖尿病视网膜病变患眼玻璃体切割手术及治疗效果的影响[J].中华眼底病杂志,2015,31(2):143-146.
[4]董明霞,李冬育,董如娇,等.不同药物玻璃体腔注射治疗弥漫性糖尿病黄斑水肿的疗效观察[J].中国实用眼科杂志,2015,33(9):980-984.
[5]李佳佳,陈彬川,李帅飞.雷珠单抗辅助双微创眼前后节联合手术治疗合并白内障的增殖性糖尿病视网膜病变[J].中国现代医学杂志,2017,12(28):124-126.
[6]El-Remessy AB,Rajesh M,Mukhopadhyay P,et al.Cannabinoid 1receptor activation contributes to vascular inflammation and cell death in a mouse model of diabetic retinopathy and a human retinal cell line[J].Diabetologia,2011,54(6):1567-1578.
[7]郭翠玲,赵仲平,何琼敏,等.雷珠单抗玻璃体腔注射对增生性糖尿病视网膜病变患者血清血管内皮生长因子的影响[J].医学综述,2016,22(10):1984-1987.
[8]陈秉文,吴星伟.中西医结合治疗非增生性糖尿病视网膜病变的临床疗效[J/OL].国际眼科杂志,2017,26(12):2234-2237.
[9]Coral K,Angayarkanni N,Gomathy N,et al.Homocysteine levels in the vitreous of proliferative diabetic retinopathy and rhegmatogenous retinal detachment:its modulating role on lysyl oxidase[J].Invest Ophthalamol Vis Sci,2009,50(8):3607-3612.
[10]王雨晴,张招德,余铮,等.玻璃体切割术联合口服荧光素钠治疗增殖性糖尿病视网膜病变[J].海南医学,2016,27(5):812-813.
[11]陈小红,陈梅珠,王云鹏,等.增生型糖尿病视网膜病变患眼玻璃体腔注射雷珠单抗治疗前后房水血管内皮生长因子和色素上皮衍生因子的浓度变化[J].中华眼底病杂志,2015,31(6):560-563.
[12]俞学群,曹国平.玻璃体切割术后高眼压的发生率和特点及相关危险因素分析[J].国际眼科杂志,2015,15(5):853-855.
[13]Spranger J,Hammes HP,Preissner KT,et al.Release of the angiogenesis inhibitor angiostatin in patients with proliferative diabetic retinpoathy:association with retinal photocoagulation[J].Diabetologia,2000,43(11):1404-1407.
[14]曾洪波,陈长征.23G和25G+玻璃体切割手术治疗增生型糖尿病视网膜病变的疗效对比观察[J].中华眼底病杂志,2014,30(2):145-147.
[15]禹海,李鹤一,王颖,等.雷珠单抗玻璃体注射与玻璃体切除术治疗增殖性糖尿病视网膜病变[J].中国实用眼科杂志,2014,32(11):1301-1305.
[2]王德功,陈松,王昀,等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重增生型糖尿病视网膜病变的临床观察[J].中华眼底病杂志,2014,30(2):136-140.
[3]付浴东,王萍,江莉,等.玻璃体腔注射雷珠单抗,全视网膜激光光凝对增生型糖尿病视网膜病变患眼玻璃体切割手术及治疗效果的影响[J].中华眼底病杂志,2015,31(2):143-146.
[4]董明霞,李冬育,董如娇,等.不同药物玻璃体腔注射治疗弥漫性糖尿病黄斑水肿的疗效观察[J].中国实用眼科杂志,2015,33(9):980-984.
[5]李佳佳,陈彬川,李帅飞.雷珠单抗辅助双微创眼前后节联合手术治疗合并白内障的增殖性糖尿病视网膜病变[J].中国现代医学杂志,2017,12(28):124-126.
[6]El-Remessy AB,Rajesh M,Mukhopadhyay P,et al.Cannabinoid 1receptor activation contributes to vascular inflammation and cell death in a mouse model of diabetic retinopathy and a human retinal cell line[J].Diabetologia,2011,54(6):1567-1578.
[7]郭翠玲,赵仲平,何琼敏,等.雷珠单抗玻璃体腔注射对增生性糖尿病视网膜病变患者血清血管内皮生长因子的影响[J].医学综述,2016,22(10):1984-1987.
[8]陈秉文,吴星伟.中西医结合治疗非增生性糖尿病视网膜病变的临床疗效[J/OL].国际眼科杂志,2017,26(12):2234-2237.
[9]Coral K,Angayarkanni N,Gomathy N,et al.Homocysteine levels in the vitreous of proliferative diabetic retinopathy and rhegmatogenous retinal detachment:its modulating role on lysyl oxidase[J].Invest Ophthalamol Vis Sci,2009,50(8):3607-3612.
[10]王雨晴,张招德,余铮,等.玻璃体切割术联合口服荧光素钠治疗增殖性糖尿病视网膜病变[J].海南医学,2016,27(5):812-813.
[11]陈小红,陈梅珠,王云鹏,等.增生型糖尿病视网膜病变患眼玻璃体腔注射雷珠单抗治疗前后房水血管内皮生长因子和色素上皮衍生因子的浓度变化[J].中华眼底病杂志,2015,31(6):560-563.
[12]俞学群,曹国平.玻璃体切割术后高眼压的发生率和特点及相关危险因素分析[J].国际眼科杂志,2015,15(5):853-855.
[13]Spranger J,Hammes HP,Preissner KT,et al.Release of the angiogenesis inhibitor angiostatin in patients with proliferative diabetic retinpoathy:association with retinal photocoagulation[J].Diabetologia,2000,43(11):1404-1407.
[14]曾洪波,陈长征.23G和25G+玻璃体切割手术治疗增生型糖尿病视网膜病变的疗效对比观察[J].中华眼底病杂志,2014,30(2):145-147.
[15]禹海,李鹤一,王颖,等.雷珠单抗玻璃体注射与玻璃体切除术治疗增殖性糖尿病视网膜病变[J].中国实用眼科杂志,2014,32(11):1301-1305.