玻璃体腔内注射康柏西普联合玻璃体切除术治疗增殖性糖尿病视网膜病变疗效观察
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摘要
目的探讨玻璃体腔内注射康柏西普联合玻璃体切除术(PPV)治疗增殖性糖尿病视网膜病变(PDR的临床效果。方法选择2016年6月至2018年9月肇庆市高要区人民医院收治的PDR患者56例(56只眼)为研究对象,以随机数表法将患者分为观察组与对照组各28例(28只眼),对照组给予常规PPV术,观察组给予玻璃体腔内注射康柏西普联合PPV手术治疗,比较两组患者术中出血发生率、手术时间、术中电凝止血率、术中医源性视网膜裂孔率、视力改变情况、再次手术率、激光补充治疗率及并发症情况。结果观察组患者的手术时间为(72.11±9.81) min,明显少于对照组的(99.21±8.11) min,术中出血发生率为10.7%,明显低于对照组的50.0%、电凝止血发生率为7.1%,明显低于对照组的57.1%,医源性视网膜裂孔发生率为10.7%,明显低于对照组的46.4%,以上各项指标比较差异均有统计学意义(P<0.05);观察组与对照组患者术后最佳矫正视力(BCVA)分别为(3.99±0.56) D、(4.01±0.32) D,均明显高于术前的(2.56±0.32) D、(2.59±0.21) D,差异均有统计学意义(P<0.05),但术后两组患者的BCVA比较差异无统计学意义(P>0.05);观察组患者术后激光补充治疗(1.51±0.90)次,明显少于对照组的(2.54±0.82)次,并发症发生率为10.7%,明显低于对照组46.4%,差异均有统计学意义(P<0.05)。结论玻璃体腔内注射康柏西普联合PPV能够有效降低PDR手术治疗难度,同时能够减少术中出血,缩短手术时间,更好的改善患者术后视力,降低术后激光补充治疗率,且并发症少,手术安全性高。
Objective To discuss the effect of intravitreal injection of Conbercept combined with pars plana vitreomy on patients with proliferative diabetic retinopathy. Methods A total of 56 patients with proliferative diabetic retinopathy(56 eyes) at Zhaoqing Gaoyao People's Hospital from Jun. 2016 to Sep. 2018 were divided into the observation group(n=28) and the control group(n=28) according to the random number table method. The observation group was treated with intravitreal injection of Conbercept combined with pars plana vitreomy, and the control group was treated with pars plana vitreomy. Then the operative time, intraoperative bleeding rate, intraoperative electrocoagulation hemostasis rate, intraoperative iatrogenic retinal hole rate, visual acuity changes, reoperation rate, laser supplementary therapy rate, and complications were compared between the two groups. Results The operative time, the incidences of bleeding, electrocoagulation hemostasis, and iatrogenic retinal hole of the observation group were(72.11±9.81) min, 10.7%,7.1%, 10.7%, significantly lower than the corresponding(99.21±8.11) min, 50.0%, 57.1%, 46.4% in the control group(P<0.05). The best-corrected visual acuity(BCVA) after the operation were(3.99±0.56) D in the observation group versus(4.01±0.32) D in the control group(P>0.05), significantly higher than(2.56±0.32) D and(2.59±0.21) D before the operation(P<0.05). The frequency of laser supplementary therapy was 1.51±0.90 in the observation group versus 2.54±0.82 in the control group(P<0.05), and the incidence of complications was 10.7% versus 46.4%(P<0.05). Conclusion Intravitreal injection of Compacil combined with pars plana vitreomy in the treatment of proliferative diabetic retinopathy can effectively reduce the difficulty of operation, shorten the operation time, reduce the incidence of intraoperative bleeding, improve the visual acuity of patients, and reduce the incidence of postoperative laser supplementation, with fewer complications and high safety.
Objective To discuss the effect of intravitreal injection of Conbercept combined with pars plana vitreomy on patients with proliferative diabetic retinopathy. Methods A total of 56 patients with proliferative diabetic retinopathy(56 eyes) at Zhaoqing Gaoyao People's Hospital from Jun. 2016 to Sep. 2018 were divided into the observation group(n=28) and the control group(n=28) according to the random number table method. The observation group was treated with intravitreal injection of Conbercept combined with pars plana vitreomy, and the control group was treated with pars plana vitreomy. Then the operative time, intraoperative bleeding rate, intraoperative electrocoagulation hemostasis rate, intraoperative iatrogenic retinal hole rate, visual acuity changes, reoperation rate, laser supplementary therapy rate, and complications were compared between the two groups. Results The operative time, the incidences of bleeding, electrocoagulation hemostasis, and iatrogenic retinal hole of the observation group were(72.11±9.81) min, 10.7%,7.1%, 10.7%, significantly lower than the corresponding(99.21±8.11) min, 50.0%, 57.1%, 46.4% in the control group(P<0.05). The best-corrected visual acuity(BCVA) after the operation were(3.99±0.56) D in the observation group versus(4.01±0.32) D in the control group(P>0.05), significantly higher than(2.56±0.32) D and(2.59±0.21) D before the operation(P<0.05). The frequency of laser supplementary therapy was 1.51±0.90 in the observation group versus 2.54±0.82 in the control group(P<0.05), and the incidence of complications was 10.7% versus 46.4%(P<0.05). Conclusion Intravitreal injection of Compacil combined with pars plana vitreomy in the treatment of proliferative diabetic retinopathy can effectively reduce the difficulty of operation, shorten the operation time, reduce the incidence of intraoperative bleeding, improve the visual acuity of patients, and reduce the incidence of postoperative laser supplementation, with fewer complications and high safety.
引文
[1]周林,李芳芳.玻璃体腔注射康柏西普联合23G玻璃体切割手术治疗增生型糖尿病视网膜病变疗效观察[J].海南医学, 2017, 28(15):2458-2461.
[2]郭学龙,陈晓霞,邓辉琳.糖尿病视网膜病变的相关危险因素分析[J].海南医学, 2018, 29(17):2394-2396.
[3]陈再洪,涂运输,许光军,等.玻璃体切割联合眼内重硅油填充治疗复杂性视网膜脱离的效果分析[J].湖南师范大学学报(医学版),2015, 12(3):133-135.
[4]许正华,冀垒兵,肖云,等.贝伐单抗辅助玻璃体切除治疗增生性糖尿病视网膜病变的观察[J].中华眼外伤职业眼病杂志, 2015, 37(10):760-763.
[5] LEASHER JL, BOURNE RR, FLAXMAN SR, et al. Global estimates on the number of people blind or visually impaired by diabetic retinopathy:a meta-analysis from 1990 to 2010[J]. Diabetes Care,2016, 39(9):1643-1649.
[6]原莉莉,张东昌,李筱荣. 23G和25G玻璃体切除术治疗增殖性糖尿病视网膜病变比较[J].中国实用眼科杂志, 2014, 32(11):1292-1295.
[7] DESCHLER EK, SUN JK, SILVA PS. Side-effects and complications oflaser treatment in diabetic retinal disease[J]. Semin Ophthalmol, 2014, 29(5/6):290-300.
[8]章晖,叶波,邱新文,等.雷珠单抗辅助23G玻璃体切割术治疗增生性糖尿病视网膜病变[J].眼科新进展, 2014, 34(10):975-977.
[9] KRIECHBAUM K, PRAGER S, MYLONAS G, et al. Intravitrealbevacizumab(Avastin)versus triamcinolone(Volon A)fortreatment ofdiabetic macular edema:one-year results[J]. Eye(Lond), 2014, 28(1):9-15.
[10]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.
[11] LI S, FU XA, ZHOU XF, et al. Angiogenesis-relatedcytokines in serum of proliferative diabetic retinopathy patients beforeand after vitrectomy[J]. Int J Ophthalmol, 2012, 5(6):726-730.
[12]张菁,蔡小军,陈晓敏,等.玻璃体腔注射康柏西普联合视网膜激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿疗效观察[J].中华眼底病杂志, 2015, 31(1):22-26.
[2]郭学龙,陈晓霞,邓辉琳.糖尿病视网膜病变的相关危险因素分析[J].海南医学, 2018, 29(17):2394-2396.
[3]陈再洪,涂运输,许光军,等.玻璃体切割联合眼内重硅油填充治疗复杂性视网膜脱离的效果分析[J].湖南师范大学学报(医学版),2015, 12(3):133-135.
[4]许正华,冀垒兵,肖云,等.贝伐单抗辅助玻璃体切除治疗增生性糖尿病视网膜病变的观察[J].中华眼外伤职业眼病杂志, 2015, 37(10):760-763.
[5] LEASHER JL, BOURNE RR, FLAXMAN SR, et al. Global estimates on the number of people blind or visually impaired by diabetic retinopathy:a meta-analysis from 1990 to 2010[J]. Diabetes Care,2016, 39(9):1643-1649.
[6]原莉莉,张东昌,李筱荣. 23G和25G玻璃体切除术治疗增殖性糖尿病视网膜病变比较[J].中国实用眼科杂志, 2014, 32(11):1292-1295.
[7] DESCHLER EK, SUN JK, SILVA PS. Side-effects and complications oflaser treatment in diabetic retinal disease[J]. Semin Ophthalmol, 2014, 29(5/6):290-300.
[8]章晖,叶波,邱新文,等.雷珠单抗辅助23G玻璃体切割术治疗增生性糖尿病视网膜病变[J].眼科新进展, 2014, 34(10):975-977.
[9] KRIECHBAUM K, PRAGER S, MYLONAS G, et al. Intravitrealbevacizumab(Avastin)versus triamcinolone(Volon A)fortreatment ofdiabetic macular edema:one-year results[J]. Eye(Lond), 2014, 28(1):9-15.
[10]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.
[11] LI S, FU XA, ZHOU XF, et al. Angiogenesis-relatedcytokines in serum of proliferative diabetic retinopathy patients beforeand after vitrectomy[J]. Int J Ophthalmol, 2012, 5(6):726-730.
[12]张菁,蔡小军,陈晓敏,等.玻璃体腔注射康柏西普联合视网膜激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿疗效观察[J].中华眼底病杂志, 2015, 31(1):22-26.