玻璃体内注射康柏西普对弥漫性糖尿病性黄斑水肿的影响
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摘要
目的探讨玻璃体内注射康柏西普对弥漫性糖尿病性黄斑水肿(diabetic macular edema,DME)的影响。方法选取2016年7月至2017年7月牡丹江医学院红旗医院眼科收治的弥漫性DME患者51例51眼,将患者分为3组,每组各17例17眼:单纯玻璃体内注射康柏西普0.5 mg组(A组);玻璃体内注射康柏西普0.5 mg联合改良黄斑格栅样光凝组(B组);单纯改良黄斑格栅样光凝组(C组)。分别于治疗前及治疗后1周、1个月、3个月和6个月对患者进行光学相干断层扫描检测黄斑中心凹厚度(central macular thickness,CMT)、眼底荧光血管造影(fundus fluorescein angiography,FFA)、最佳矫正视力(best corrected visual acuity,BCVA)、裂隙灯、眼压等检查,比较三种治疗方式的疗效和安全性。结果三种治疗方式均能改善弥漫性DME患者BCVA、CMT、视网膜新生血管渗漏,但A组、B组疗效均优于C组(均为P<0.05)。A组、B组患者BCVA改善情况差异无统计学意义(P>0.05),但B组患者CMT(197.47±45.26)μm及视网膜新生血管渗漏(9.91±3.18)mm~2改善情况优于A组(205.59±47.33)μm、(13.24±4.87)mm~2(P<0.001),且无光凝术及康柏西普相关的并发症发生。结论改良黄斑格栅样光凝术联合玻璃体内注射康柏西普能迅速减轻弥漫性DME及新生血管形成,从而提高患者视力,其疗效优于单纯改良黄斑格栅样光凝术和单纯康柏西普玻璃体内注射。
Objective To investigate the effects of intravitreal injection of conbercept on diffuse macular edema( DM E) of diabetes mellitus. Methods T ogether 51 diabetic patients( 51 eyes) with diffuse macular edema w ere collected betw een July 2016 to July2017,and randomly divided into three groups( n = 17) : group A, in w hich patients received solely intravitreal injection of 0. 5 mg conbercept,group B,those who was intravitreally injected w ith 0. 5 mg of conbercept and modified macular grating photocoagulation,and group C,patients undergoing modified grid photocoagulation( GPG). T hen,before treatment and 1 week,1 month,3 months and 6 months after treatment,all patients w ere examined by optical coherence tomography for determining central macular thickness( CM T),follow ed by fundus fluorescein angiography( FFA),the best corrected visual acuity( BC VA),slit lamp, intraocular pressure for compare the efficacy and safety of the three procedures. Results All the three treatments improved BC VA,CM T,r etinal neovascularization( RNV) leakage in diffuse DM E patients,but group A and B w ere better than group C( both P < 0. 05),w hile there w as no significant difference in BC VA improvement betw een A and B group( P > 0. 05),w hereas the improvement in CMT of group B patients was better than that of group A [( 197. 47 ± 45. 26) μm vs.( 205. 59 ± 47.33) μm]( P < 0. 001),and this was true of RNV leakage [( 9. 91 ± 3. 18) mm vs.( 13. 24 ± 4.87) mm]( P < 0. 001),without related complications. Conclusion Combination of modified macular grid photocoagulation and intravitreal injection of conbercept can quickly relieve diabetic macular edema and alleviate neovascularization,thus improving the patients' vision acuity,o f which the efficacy is superior to the pure modified macular grid photocoagulation and conbercept injection.
Objective To investigate the effects of intravitreal injection of conbercept on diffuse macular edema( DM E) of diabetes mellitus. Methods T ogether 51 diabetic patients( 51 eyes) with diffuse macular edema w ere collected betw een July 2016 to July2017,and randomly divided into three groups( n = 17) : group A, in w hich patients received solely intravitreal injection of 0. 5 mg conbercept,group B,those who was intravitreally injected w ith 0. 5 mg of conbercept and modified macular grating photocoagulation,and group C,patients undergoing modified grid photocoagulation( GPG). T hen,before treatment and 1 week,1 month,3 months and 6 months after treatment,all patients w ere examined by optical coherence tomography for determining central macular thickness( CM T),follow ed by fundus fluorescein angiography( FFA),the best corrected visual acuity( BC VA),slit lamp, intraocular pressure for compare the efficacy and safety of the three procedures. Results All the three treatments improved BC VA,CM T,r etinal neovascularization( RNV) leakage in diffuse DM E patients,but group A and B w ere better than group C( both P < 0. 05),w hile there w as no significant difference in BC VA improvement betw een A and B group( P > 0. 05),w hereas the improvement in CMT of group B patients was better than that of group A [( 197. 47 ± 45. 26) μm vs.( 205. 59 ± 47.33) μm]( P < 0. 001),and this was true of RNV leakage [( 9. 91 ± 3. 18) mm vs.( 13. 24 ± 4.87) mm]( P < 0. 001),without related complications. Conclusion Combination of modified macular grid photocoagulation and intravitreal injection of conbercept can quickly relieve diabetic macular edema and alleviate neovascularization,thus improving the patients' vision acuity,o f which the efficacy is superior to the pure modified macular grid photocoagulation and conbercept injection.
引文
[1]BANDELLO F,BATTAGLIA PARODI M,TREMOLADA G,LATTANZIO R,DE BENEDET T O U,IACONO P.Steroids as part of combination treatment:T he future for the management of macular edema[J].Ophthalmologica,2010,224(Suppl 1):41-45.
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[6]LI SH,GAO YF.Efficacy of macular focal/grid photocoagulation combined with ranibizumab for diabetic macular edema[J].Rec Adv Ophthalmol,2015,35(6):566-568,575.李素华,高永峰.比较单独黄斑局灶/格栅样光凝术和联合雷珠单抗治疗糖尿病性黄斑水肿的疗效[J].眼科新进展,2015,35(6):566-568,575.
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[8]ZHANG YC,ZHAO H,ZHANG XLGAO YC,WU CY,HE JQ,et al.Changes of serum retinal,adiponectin,visfatin levels in type 2 diabetes mellitus combined with hy-pertension patients[J].J Xinxiang Med Univ,2014,31(12):1039-1041.张宇晨,赵华,张晓林,高阅春,吴长燕,何继强,等.2型糖尿病合并高血压患者血清网膜素、脂联素及内脂素水平变化[J].新乡医学院学报,2014,31(12):1039-1041.
[9]LI H,CAO H,WANG YS.Recent advances on laser treatment in dia-betic retinopathy[J].Rec Adv Ophthalmol,2010,30(5):489-492.李红,曹虹,王雨生.激光治疗糖尿病视网膜病变的研究进展[J].眼科新进展,2010,30(5):489-492.
[10]HAN J,WANG L,LIU WX,SUN HL,CAI W.Effects of compaq sipp intravitreal injection on visual acuity of diabetic retinopathy[J].Chin Gen Pract,2015,18(5):502-506.韩姬,王玲,刘伟仙,孙宏亮,蔡维.康柏西普玻璃体腔注射对糖尿病视网膜病变患者视力的影响[J].中国全科医学,2015,18(5):502-506.
[11]ELMAN MJ,BECK RW,BRESSLER NM,BRESSLER SB,EDWARDS AR,et al.Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema[J].Ophthalmology,2010,117(6):1064-1077.
[2]DEISSLER HL,LANG GK,LANG GE.Capacity of aflibercept to counteract VEGF-stimulated abnormal behavior of retinal microvascular endothelial cells[J].Exp Eye Res,2014,122(5):20-31.
[3]BOYER DS,YOON YH,RUBENS BJ,FRANCESCOB,MAT URI RJ,AUGUST IN AJ,et al.T hree-year,randomized,shamcontrolled trial of dexamethasone intravitreal implant in patients with diabetic macular edema[J].Ophthalmology,2014,121(10):1904-1914.
[4]LI XX,XU GZ,WANG YS,XU X,LIU XL,T ANG SB,et al.Safety and efficacy of conbercept in neovascular age-related macular degeneration:results from a 12-month randomized phase 2study:Aurora study[J].Ophthalmology,2014,121(9):1740-1747.
[5]DU LP,PENG H,WU QUAN,ZHU MD,LUO DL,KE X,et al.Observation of total VEGF level in hyperglycemic mouse eyes after intravitreal injection of the novel anti-VEGF drug conbercept[J].Mol Vis,2015,21(2):185-193.
[6]LI SH,GAO YF.Efficacy of macular focal/grid photocoagulation combined with ranibizumab for diabetic macular edema[J].Rec Adv Ophthalmol,2015,35(6):566-568,575.李素华,高永峰.比较单独黄斑局灶/格栅样光凝术和联合雷珠单抗治疗糖尿病性黄斑水肿的疗效[J].眼科新进展,2015,35(6):566-568,575.
[7]W EI GJ,HE DJ.532nm green grid laser photocoagulationcombined with intravitreal Avastin injectionfor diabetic retinopathy macular edema[J].Rec Adv Ophthalmol,2014,34(8):779-781.魏光杰,何佃菊.532nm绿激光格栅样光凝联合球内注药治疗糖尿病视网膜病变黄斑水肿[J].眼科新进展,2014,34(8):779-781.
[8]ZHANG YC,ZHAO H,ZHANG XLGAO YC,WU CY,HE JQ,et al.Changes of serum retinal,adiponectin,visfatin levels in type 2 diabetes mellitus combined with hy-pertension patients[J].J Xinxiang Med Univ,2014,31(12):1039-1041.张宇晨,赵华,张晓林,高阅春,吴长燕,何继强,等.2型糖尿病合并高血压患者血清网膜素、脂联素及内脂素水平变化[J].新乡医学院学报,2014,31(12):1039-1041.
[9]LI H,CAO H,WANG YS.Recent advances on laser treatment in dia-betic retinopathy[J].Rec Adv Ophthalmol,2010,30(5):489-492.李红,曹虹,王雨生.激光治疗糖尿病视网膜病变的研究进展[J].眼科新进展,2010,30(5):489-492.
[10]HAN J,WANG L,LIU WX,SUN HL,CAI W.Effects of compaq sipp intravitreal injection on visual acuity of diabetic retinopathy[J].Chin Gen Pract,2015,18(5):502-506.韩姬,王玲,刘伟仙,孙宏亮,蔡维.康柏西普玻璃体腔注射对糖尿病视网膜病变患者视力的影响[J].中国全科医学,2015,18(5):502-506.
[11]ELMAN MJ,BECK RW,BRESSLER NM,BRESSLER SB,EDWARDS AR,et al.Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema[J].Ophthalmology,2010,117(6):1064-1077.