雷珠单抗预防伴有虹膜新生血管的糖尿病视网膜病变术后再出血疗效观察
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摘要
目的研究雷珠单抗预防伴有虹膜新生血管的糖尿病视网膜病变玻璃体切割术后再出血的疗效。方法回顾性分析2009年至2015年在我院因糖尿病视网膜病变行玻璃体切割术后出现虹膜新生血管的患者70例(70眼)的临床资料。对照组30例(30眼)行全视网膜激光光凝,多次玻璃体手术、睫状体冷冻等治疗,研究组40例(40眼)术前玻璃体内注射雷珠单抗0.5 mg后联合各项治疗,随访3个月,对比分析两组患者视力、眼压、新生血管消退及并发症等情况。结果术后1个月、2个月时,研究组视力优于对照组,但随着时间的延长,两组视力无明显差异。研究组、对照组术前眼压分别为(26.312±4.566)mmHg(1 kPa=7.5 mmHg)、(25.586±5.783)mmHg,两组相比差异无统计学意义(P=0.687);随访期末眼压分别为(18.576±4.762)mmHg、(28.587±7.786)mmHg,两组相比差异有统计学意义(P=0.041)。对照组术中、术后出现前房和(或)玻璃体积血者分别为12例、5例,研究组为3例、1例,两组术中、术后积血比例相比差异均有统计学意义(均为P=0.000)。随访期末研究组3眼(7.5%)进展为新生血管性青光眼,对照组为10眼(33.3%),两组相比差异有统计学意义(P<0.05)。结论糖尿病视网膜病变术后伴有虹膜新生血管时,雷珠单抗可以有效消除新生血管,减少新生血管性青光眼的发生率,并减少前房、玻璃体积血的发生率,在一定时间内有效提高患者视力。
Objective To study the effects of lucentis preventing vitreous hemorrhage after vitrectomy for diabetic retinopathy combined with iris neovascularization.Methods The clinical data of 70 patients( 70 eyes) underwent vitrectomy for diabetic retinopathy combined with iris neovascularization during 2009 to 2015 in our hospital were retrospectively analyzed.The control group( 30 eyes) accepted panretinal photocoagulation( PRP), re-vitrectomy, cyclocryotherapy,and the study group( 40 eyes) had the 0.5mg lucentis in addition. The follow-up time was 3months, and the visual acuity, IOP,vitreous hemorrhage, INV regression and complication were observed.Results At 1 month,2 months in the follow-up,the visual acuity of study group was better than the control group,but there was no significant difference along with the follow up.The average preoperative IOP was( 26.312±4.566) mmHg( 1 kPa = 7.5 mmHg) in the study group and( 24.586±5.783) mmHg in the control group, and at the end of the follow up, IOP was( 18.576± 4. 762) mmHg in the study group and( 28. 587 ± 7. 786) mmHg in the control group,there was statistical difference between the two groups( P= 0.041).The intraoperative and postoperative anterior chamber or vitreous hemorrhage occurred in 15 cases,5 cases of the control group, and 3 cases,1 case of the control group,t here were significant differences( all P= 0.000).At the end of the follow up,3 eyes( 7.5%) developed to NVG in the study group and 10 eyes( 33.3%) in the control group,there was statistical difference( P<0.05).Conclusion Lucentis can effectively eliminate the new vessels, reduce the incidence of neovascularization glaucoma and vitreous hemorrhage for patients after vitrectomy for diabetic retinopathy combined with iris neovascularization,and improve the visual acuity in a short time.
Objective To study the effects of lucentis preventing vitreous hemorrhage after vitrectomy for diabetic retinopathy combined with iris neovascularization.Methods The clinical data of 70 patients( 70 eyes) underwent vitrectomy for diabetic retinopathy combined with iris neovascularization during 2009 to 2015 in our hospital were retrospectively analyzed.The control group( 30 eyes) accepted panretinal photocoagulation( PRP), re-vitrectomy, cyclocryotherapy,and the study group( 40 eyes) had the 0.5mg lucentis in addition. The follow-up time was 3months, and the visual acuity, IOP,vitreous hemorrhage, INV regression and complication were observed.Results At 1 month,2 months in the follow-up,the visual acuity of study group was better than the control group,but there was no significant difference along with the follow up.The average preoperative IOP was( 26.312±4.566) mmHg( 1 kPa = 7.5 mmHg) in the study group and( 24.586±5.783) mmHg in the control group, and at the end of the follow up, IOP was( 18.576± 4. 762) mmHg in the study group and( 28. 587 ± 7. 786) mmHg in the control group,there was statistical difference between the two groups( P= 0.041).The intraoperative and postoperative anterior chamber or vitreous hemorrhage occurred in 15 cases,5 cases of the control group, and 3 cases,1 case of the control group,t here were significant differences( all P= 0.000).At the end of the follow up,3 eyes( 7.5%) developed to NVG in the study group and 10 eyes( 33.3%) in the control group,there was statistical difference( P<0.05).Conclusion Lucentis can effectively eliminate the new vessels, reduce the incidence of neovascularization glaucoma and vitreous hemorrhage for patients after vitrectomy for diabetic retinopathy combined with iris neovascularization,and improve the visual acuity in a short time.
引文
[1]李军,祝莹,徐少凯.多种方法联合治疗新生血管性青光眼的疗效[J].国际眼科杂志,2015,15(4):704-706.LI J,ZHU Y,XU SK.Therapeutic effects of combination therapy for neovascular glaucoma[J].Int J Ophthalmol,2015,15(4):704-706.
[2]曹雨露,万光明,杨会琴,梁申芝,魏晓飞.虹膜红变糖尿病视网膜病变雷珠单抗眼内注射后玻璃体切除术的体会[J].中华眼外伤职业眼病杂志,2015,37(5):326-329.CAO YL,WAN GM,YANG HQ,LIANG SZ,WEI XF.The experience of vitrectomy for diabetic retinopathy with rubeosis iridis after intravitreal injection of ranibizumab[J].Chin J Ocul Traum Occupat Eye Dis,2015,37(5):326-329.
[3]YEH PT,YANG CH,YANG CM.Intravitreal bevacizumab injection for recurrent vitreous hemorrhage after diabetic vitrectomy[J].Acta Ophthalmol,2011,89(7):634-640.
[4]BROWN GC,TASMAN WS,BENSON WE,MCNAMARAJA,EAGLE RC.Reoperation following diabetic vitrectomy[J].Arch Ophthalmol,1992,110(4):506-510.
[5]GOTO A,INATANI M,INOUE T,AWAI-KASAOKA N,TAKIHARA Y,ITO Y,et al.Frequency and risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy[J].J G laucoma,2013,22(7):572-576.
[6]万新顺,刘瑞芳,李超.新生血管性青光眼患者眼内血管内皮生长因子浓度对虹膜新生血管的影响[J].新乡医学院学报,2009,26(3):256.WAN XS,LIU RF,LI C.The effect of the levels of the vascular endothelial growth factor in ocular fluid of patients with neovascular glaucoma on the neovascularization of iris[J].J Xinxiang Med Univ,2009,26(3):256.
[7]KUZMIN A,LIPATOV D,CHISTYAKOV T,SMIMOVAL O,ARBUZOVA M,ILIN A,et al.Vascular endothelial growth factor in anterior chamber liquid patients with diabetic retinopathy[J].Ophthalmol Ther,2013,2(1):41-51.
[8]LUKE J,NASSAR K,ML,GRISANTI S.Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma-results from a prospective interventional case series[J].G raefes Arch Clin Exp Ophthalmol,2013,251(10):2403-2413.
[9]ILIEV ME,DOMIG D,CHNURRBURSCH UW,WOLF S,SARRA GM.Intravitreal bevacizumab(Avastin)in the treatment of neovascular glaucoma[J].Am J Ophthalmol,2006,142(6):1054-1056.
[10]MASON JO,ALBERT MA,MAYS A,VAIL R.Regression of neovascular iris vessels by intravitreal injection of bevacizumab[J].Retina,2006,26(7):839-841.
[11]SOOHOO JR,SEIBOLD LK,KAHOOK MY.Recent advances in the management of neovascular glaucoma[J].Semin Ophthalmol,2013,28(3):165-172.
[12]AVERY RL,PEARLMAN J,PIERAMICI DJ,MELVIN R,ALESSANDROC,NASIR MA,et al.Intravitreal bevacizumab(Avastin)in the treatment of proliferative diabetic retinopathy[J].Ophthalmology,2006,113(10):1695-1705.
[13]ISAACS TW,BARRY C.Rapid resolution of severe disc new vessels in proliferative diabetic retinopathy following a single intravitreal injection of bevacizumab(Avastin)[J].Clin Exp Ophthalmol,2006,34(8):802-803.
[14]MINNELLA AM,SAVASTANO CM,ZICCARDI L,SCUPOLALA,SASSOL P,FALSINI B,et al.Intravitreal bevacizumab(Avastin)in proliferative diabetic retinopathy[J].Acta Ophthalmol,2008,86(6):683-687.
[15]RUIZ-MORENO JM,MONTERO JA,LUGO F,AMAT P,STAICU C.Intravitreal bevacizumab in recurrent diabetic vitreous haemorrhage after vitrectomy[J].Acta Ophthalmol,2008,86(2):231-232.
[16]GARWEG JG,WENZEL A.Diabetic maculopathy and retinopathy functional and sociomedical significance[J].Ophthalmology,2010,107(7):628-635.
[17]MASSIN P,BANDELLO F,GARWEG JG,HANSEN LL,HARDING SP,LARSEN M,et al.Safety and efficacy of ranibizumab in diabetic macular edema(RESOLVE Study):a 12month,randomized,controlled,double-masked,multicenter phaseⅡstudy[J].Diabetes Care,2010,33(11):2399-2405.
[18]QAUM T,XU Q,JOUSSEN AM,CLEMENS MW,QIN W,MIYAMOTO K,et al.VEGF-initiated blood-retinal barrier breakdown in early diabetes[J].Invest Ophthalmol Vis Sci,2001,42(10):2408-2413.
[19]BANDELLO F,CICINELLI MV,PARODI MB.Anti-VEGF molecules for the management of diabetic macular edema[J].Curr Pharm Des,2015,21(32):4731-4737.
[20]KROHNE TU,LIU Z,HOLZ FG,MRYRE-CARSTEN H.Intraocular pharmaeokinetics of ranibizumab following a single intravitreal injection in humans[J].Am J Ophthalmol,2012,154(4):682-686.
[21]ALKAW AS,AYMAN A,SHAHIE N,EZZAT A,HUSSE IN,ATEF M,et al.Management of neovasular glaucoma with panretinal photocoagnlation,intravitreal bevacizumab,and subsequent trabeculectomy with mitomycin C[J].J G laucoma,2010,19(9):622-626.
[22]LUKE J,NASSAR K,LUKE M,GRISANTI S.Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucomaresults from a prospective interventional caseseries[J].G raefes Arch Clin Exp Ophthalmol,2013,251(10):2403-2413.
[23]NAKATAKE S,YOSHIDA S,NAKAO S,ARITA R,YASUDAM,KITA T,et al.Hyphema is a risk factor for failure of trabeculectomy in neovascular glaucoma:aretrospective analysis[J].BMCOphthalmol,2014,14(1):1-7.
[2]曹雨露,万光明,杨会琴,梁申芝,魏晓飞.虹膜红变糖尿病视网膜病变雷珠单抗眼内注射后玻璃体切除术的体会[J].中华眼外伤职业眼病杂志,2015,37(5):326-329.CAO YL,WAN GM,YANG HQ,LIANG SZ,WEI XF.The experience of vitrectomy for diabetic retinopathy with rubeosis iridis after intravitreal injection of ranibizumab[J].Chin J Ocul Traum Occupat Eye Dis,2015,37(5):326-329.
[3]YEH PT,YANG CH,YANG CM.Intravitreal bevacizumab injection for recurrent vitreous hemorrhage after diabetic vitrectomy[J].Acta Ophthalmol,2011,89(7):634-640.
[4]BROWN GC,TASMAN WS,BENSON WE,MCNAMARAJA,EAGLE RC.Reoperation following diabetic vitrectomy[J].Arch Ophthalmol,1992,110(4):506-510.
[5]GOTO A,INATANI M,INOUE T,AWAI-KASAOKA N,TAKIHARA Y,ITO Y,et al.Frequency and risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy[J].J G laucoma,2013,22(7):572-576.
[6]万新顺,刘瑞芳,李超.新生血管性青光眼患者眼内血管内皮生长因子浓度对虹膜新生血管的影响[J].新乡医学院学报,2009,26(3):256.WAN XS,LIU RF,LI C.The effect of the levels of the vascular endothelial growth factor in ocular fluid of patients with neovascular glaucoma on the neovascularization of iris[J].J Xinxiang Med Univ,2009,26(3):256.
[7]KUZMIN A,LIPATOV D,CHISTYAKOV T,SMIMOVAL O,ARBUZOVA M,ILIN A,et al.Vascular endothelial growth factor in anterior chamber liquid patients with diabetic retinopathy[J].Ophthalmol Ther,2013,2(1):41-51.
[8]LUKE J,NASSAR K,ML,GRISANTI S.Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma-results from a prospective interventional case series[J].G raefes Arch Clin Exp Ophthalmol,2013,251(10):2403-2413.
[9]ILIEV ME,DOMIG D,CHNURRBURSCH UW,WOLF S,SARRA GM.Intravitreal bevacizumab(Avastin)in the treatment of neovascular glaucoma[J].Am J Ophthalmol,2006,142(6):1054-1056.
[10]MASON JO,ALBERT MA,MAYS A,VAIL R.Regression of neovascular iris vessels by intravitreal injection of bevacizumab[J].Retina,2006,26(7):839-841.
[11]SOOHOO JR,SEIBOLD LK,KAHOOK MY.Recent advances in the management of neovascular glaucoma[J].Semin Ophthalmol,2013,28(3):165-172.
[12]AVERY RL,PEARLMAN J,PIERAMICI DJ,MELVIN R,ALESSANDROC,NASIR MA,et al.Intravitreal bevacizumab(Avastin)in the treatment of proliferative diabetic retinopathy[J].Ophthalmology,2006,113(10):1695-1705.
[13]ISAACS TW,BARRY C.Rapid resolution of severe disc new vessels in proliferative diabetic retinopathy following a single intravitreal injection of bevacizumab(Avastin)[J].Clin Exp Ophthalmol,2006,34(8):802-803.
[14]MINNELLA AM,SAVASTANO CM,ZICCARDI L,SCUPOLALA,SASSOL P,FALSINI B,et al.Intravitreal bevacizumab(Avastin)in proliferative diabetic retinopathy[J].Acta Ophthalmol,2008,86(6):683-687.
[15]RUIZ-MORENO JM,MONTERO JA,LUGO F,AMAT P,STAICU C.Intravitreal bevacizumab in recurrent diabetic vitreous haemorrhage after vitrectomy[J].Acta Ophthalmol,2008,86(2):231-232.
[16]GARWEG JG,WENZEL A.Diabetic maculopathy and retinopathy functional and sociomedical significance[J].Ophthalmology,2010,107(7):628-635.
[17]MASSIN P,BANDELLO F,GARWEG JG,HANSEN LL,HARDING SP,LARSEN M,et al.Safety and efficacy of ranibizumab in diabetic macular edema(RESOLVE Study):a 12month,randomized,controlled,double-masked,multicenter phaseⅡstudy[J].Diabetes Care,2010,33(11):2399-2405.
[18]QAUM T,XU Q,JOUSSEN AM,CLEMENS MW,QIN W,MIYAMOTO K,et al.VEGF-initiated blood-retinal barrier breakdown in early diabetes[J].Invest Ophthalmol Vis Sci,2001,42(10):2408-2413.
[19]BANDELLO F,CICINELLI MV,PARODI MB.Anti-VEGF molecules for the management of diabetic macular edema[J].Curr Pharm Des,2015,21(32):4731-4737.
[20]KROHNE TU,LIU Z,HOLZ FG,MRYRE-CARSTEN H.Intraocular pharmaeokinetics of ranibizumab following a single intravitreal injection in humans[J].Am J Ophthalmol,2012,154(4):682-686.
[21]ALKAW AS,AYMAN A,SHAHIE N,EZZAT A,HUSSE IN,ATEF M,et al.Management of neovasular glaucoma with panretinal photocoagnlation,intravitreal bevacizumab,and subsequent trabeculectomy with mitomycin C[J].J G laucoma,2010,19(9):622-626.
[22]LUKE J,NASSAR K,LUKE M,GRISANTI S.Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucomaresults from a prospective interventional caseseries[J].G raefes Arch Clin Exp Ophthalmol,2013,251(10):2403-2413.
[23]NAKATAKE S,YOSHIDA S,NAKAO S,ARITA R,YASUDAM,KITA T,et al.Hyphema is a risk factor for failure of trabeculectomy in neovascular glaucoma:aretrospective analysis[J].BMCOphthalmol,2014,14(1):1-7.