康柏西普和雷珠单抗治疗弥漫性糖尿病性黄斑水肿的疗效比较
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摘要
目的比较康柏西普和雷珠单抗治疗弥漫性糖尿病性黄斑水肿(DME)的疗效。方法选取弥漫性DME患者50例(50眼),分为A组及B组各25例(25眼),分别给予玻璃体腔内注射康柏西普0.5 mg、雷珠单抗0.5 mg。于治疗前及治疗后1周、1个月、3个月和6个月对患者进行最佳矫正视力(BCVA)、眼压检查,并应用光相干断层扫描检测黄斑中心厚度(CMT)、眼底荧光血管造影检查视网膜新生血管(RNV)渗漏面积,同时观察各时间点有无眼内炎、睫状体脱离等眼部并发症的发生情况。结果治疗前后,两组间视力及眼压比较,差异均无统计学意义(P>0.05),两组的视力及眼压均无随时间变化的趋势(P>0.05)。A组治疗后各时间点的CMT均薄于B组(均P<0.05),两组的CMT均有随时间变化的趋势(P<0.05)。A组治疗后各时间点的RNV渗漏面积均小于B组(P<0.05),两组的RNV渗漏面积均有随时间变化的趋势(P<0.05)。随访期间两组均无眼内炎、睫状体脱离、抗血管内皮生长因子药物相关的急性高血压、心血管意外和血栓栓塞等并发症发生。结论对于弥漫性DME患者玻璃体腔内注射康柏西普在减轻黄斑水肿、减少视网膜新生血管渗漏面积方面效果优于玻璃体腔内注射雷珠单抗。
Objective To compare the efficacy between conbercept and ranibizumab for the treatment of diffuse diabetic macular edema( DME). Methods Fifty patients(50 eyes) with diffuse DME were divided into 25 cases in group A( 25 eyes) and 25 cases in group B(25 eyes). Group A was given intravitreal injection of 0. 5 mg conbercept,while group B was given intravitreal injection of 0. 5 mg ranibizumab. Before and after 1 week,1,3 and 6 months of treatment,the best corrected visual acuity( BCVA) and intraocular pressure were detected in all patients,optical coherence tomography was used to determine the center of macular thickness( CMT),and fundus fluorescence angiography( FFA) to measure the retinal neovascularization( RNV) leakage area. And the incidence of ocular complications,such as endophthalmitis and cyclodialysis,was observed at each time point as well. Results Before and after treatment,no significant differences were found in the visual acuity or intraocular pressure between the two groups( P > 0. 05). In the two groups,the visual acuity or intraocular pressure did not present a tendency of changing over time( P > 0. 05). At each time point after treatment,the CMT of group A was thinner than that of group B( all P < 0. 05),and CMT changed over time in both group( P < 0. 05). At each time point after treatment,the RNV leakage area of group A was smaller than that of group B( P < 0. 05),and RNV leakage area changed over time in both groups(P < 0. 05). During follow-up,neither the ocular complications,such as endophthalmitis and cyclodialysis,or the systemic complications,including anti-vascular endothelial growth factor drugs-related acute hypertension,cardiovascular events and thromboembolism,occurred.Conclusion For diffuse DME,intravitreal injection of conbercept is superior to intravitreal injection of ranibizumab in the terms of alleviating macular edema and reducing RNV leakage area.
Objective To compare the efficacy between conbercept and ranibizumab for the treatment of diffuse diabetic macular edema( DME). Methods Fifty patients(50 eyes) with diffuse DME were divided into 25 cases in group A( 25 eyes) and 25 cases in group B(25 eyes). Group A was given intravitreal injection of 0. 5 mg conbercept,while group B was given intravitreal injection of 0. 5 mg ranibizumab. Before and after 1 week,1,3 and 6 months of treatment,the best corrected visual acuity( BCVA) and intraocular pressure were detected in all patients,optical coherence tomography was used to determine the center of macular thickness( CMT),and fundus fluorescence angiography( FFA) to measure the retinal neovascularization( RNV) leakage area. And the incidence of ocular complications,such as endophthalmitis and cyclodialysis,was observed at each time point as well. Results Before and after treatment,no significant differences were found in the visual acuity or intraocular pressure between the two groups( P > 0. 05). In the two groups,the visual acuity or intraocular pressure did not present a tendency of changing over time( P > 0. 05). At each time point after treatment,the CMT of group A was thinner than that of group B( all P < 0. 05),and CMT changed over time in both group( P < 0. 05). At each time point after treatment,the RNV leakage area of group A was smaller than that of group B( P < 0. 05),and RNV leakage area changed over time in both groups(P < 0. 05). During follow-up,neither the ocular complications,such as endophthalmitis and cyclodialysis,or the systemic complications,including anti-vascular endothelial growth factor drugs-related acute hypertension,cardiovascular events and thromboembolism,occurred.Conclusion For diffuse DME,intravitreal injection of conbercept is superior to intravitreal injection of ranibizumab in the terms of alleviating macular edema and reducing RNV leakage area.
引文
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[4]马进,吴德正,高汝龙,等.糖尿病性黄斑水肿患者玻璃体手术后黄斑区视功能的转归[J].中华眼科杂志,2005,41(3):216-220.
[5]张宇晨,赵华,张晓林,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):1 039-1 041.
[6]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]韩姬,王玲,刘伟仙,等.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.
[8]何旭亭,王大龙,张宏,等.康柏西普玻璃体腔注射治疗湿性年龄相关性黄斑变性[J].国际眼科杂志,2015,13(9):1 603-1 605.
[9]李婷婷,牛彤彤,王海林.玻璃体腔注射雷珠单抗联合Tenon囊注射曲安奈德治疗CRVO继发黄斑水肿[J].国际眼科杂志,2015,13(1):98-100.
[10]孙梅,李明新.糖尿病视网膜病变围手术期的抗VEGF研究[J].国际眼科杂志,2015,15(10):1 772-1 774.
[11]丁国鹏,丁国龙,雷姝,等.康柏西普联合577 nm微脉冲激光治疗糖尿病性黄斑水肿临床观察[J].国际眼科杂志,2015,15(11):1 942-1 944.
[12]牛静宜,金玲,刘晓红,等.雷珠单抗与康柏西普治疗湿性老年性黄斑变性的疗效对比[J].广西医学,2016,38(5):641-643,670.
[13]何海燕,陈子林.康柏西普治疗老年性黄斑变性的研究现状[J].国际眼科杂志,2015,15(8):1 367-1 369.
[14]徐浩,白宁艳,吕鹏,等.雷珠单抗玻璃体内注射与黄斑部格栅样光凝联合治疗糖尿病黄斑水肿的疗效观察[J].眼科新进展,2015,35(8):781-783.
[2]Boyer DS,Yoon YH,Belfort R,et al.Three-year,randomized,sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema[J].Ophthalmology,2014,121(10):1 904-1 914.
[3]杨钧,张福燕,李建阳.糖尿病性黄斑水肿及其检查[J].中华临床医师杂志(电子版),2015,32(5):821-824.
[4]马进,吴德正,高汝龙,等.糖尿病性黄斑水肿患者玻璃体手术后黄斑区视功能的转归[J].中华眼科杂志,2005,41(3):216-220.
[5]张宇晨,赵华,张晓林,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):1 039-1 041.
[6]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]韩姬,王玲,刘伟仙,等.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.
[8]何旭亭,王大龙,张宏,等.康柏西普玻璃体腔注射治疗湿性年龄相关性黄斑变性[J].国际眼科杂志,2015,13(9):1 603-1 605.
[9]李婷婷,牛彤彤,王海林.玻璃体腔注射雷珠单抗联合Tenon囊注射曲安奈德治疗CRVO继发黄斑水肿[J].国际眼科杂志,2015,13(1):98-100.
[10]孙梅,李明新.糖尿病视网膜病变围手术期的抗VEGF研究[J].国际眼科杂志,2015,15(10):1 772-1 774.
[11]丁国鹏,丁国龙,雷姝,等.康柏西普联合577 nm微脉冲激光治疗糖尿病性黄斑水肿临床观察[J].国际眼科杂志,2015,15(11):1 942-1 944.
[12]牛静宜,金玲,刘晓红,等.雷珠单抗与康柏西普治疗湿性老年性黄斑变性的疗效对比[J].广西医学,2016,38(5):641-643,670.
[13]何海燕,陈子林.康柏西普治疗老年性黄斑变性的研究现状[J].国际眼科杂志,2015,15(8):1 367-1 369.
[14]徐浩,白宁艳,吕鹏,等.雷珠单抗玻璃体内注射与黄斑部格栅样光凝联合治疗糖尿病黄斑水肿的疗效观察[J].眼科新进展,2015,35(8):781-783.