康柏西普治疗糖尿病视网膜病变及其伴发黄斑水肿的临床应用研究
|
摘要
目的:评价玻璃体腔注射康柏西普(Conbercept)治疗糖尿病视网膜病变(DR)的有效性、安全性及对增殖型糖尿病视网膜病变(PDR)玻璃体切除术的影响。方法:回顾性分析在大理大学第三附属医院接受玻璃体腔注射康柏西普的各种DR患者56例(80眼),其中非增殖性糖尿病视网膜(NPDR)患者30例(52眼),严重增殖性糖尿病视网膜病变(PDR)患者26例(28眼)进行玻璃体切除(PPV),随机分为术前玻璃体腔注射康柏西普联合玻璃体切除术组(IVC/PPV例(12眼)。结果:NPDR患者眼底病变不同程度获得改善,新生血管明显得到抑制,黄斑水肿有一定的改善、吸收,最佳矫正视力(BCVA)有不同程度提高。IVC/PPV组明显有利于手术操作。结论:玻璃体腔注射康柏西普治疗NPDR疗效显著,对拟行玻璃体切除的严重PDR患者,能有效降低手术难度,减少手术并发症的发生,是糖尿病视网膜病变治疗的主流选择。
Objective: To evaluate the efficacy and safety of Conbercept intravitreal injections in treatment of diabetic retinopathy,and its effects on vitrectomy for proliferative diabetic retinopathy(PDR). Methods: We retrospectively analyzed 56 patients(80 eyes)with DR who received Conbercept intravitreal injection in our hospital. 30 patients(62 eyes)had NPDR, and 26(28 eyes)with severe PDR underwent vitreous resection(PPV). The latter was randomly divided into the IVC&PPV group in which 15 patients(16 eyes)were treated with conbercept intravitreal injection in combination with vitrectomy and the PPV group in which 11 patients(12 eyes)underwent vitrectomy. Results: Among patients with NPDR, their diabetic retinopathy was improved in varying degrees,neovascularization was significantly inhibited, macular edema was improved and absorbed, and visual acuity was corrected in different degrees. IVC/PPV was significantly favorable for surgical operations. Conclusion: Intravitreal injection of Conbercept is an effective treatment for NPDR. For severe PDR patients who are undergoing vitrectomy, it can effectively reduce the difficulty of surgery and reduce the occurrence of surgical complications, so it is the mainstream choice for the treatment of diabetic retinopathy.
Objective: To evaluate the efficacy and safety of Conbercept intravitreal injections in treatment of diabetic retinopathy,and its effects on vitrectomy for proliferative diabetic retinopathy(PDR). Methods: We retrospectively analyzed 56 patients(80 eyes)with DR who received Conbercept intravitreal injection in our hospital. 30 patients(62 eyes)had NPDR, and 26(28 eyes)with severe PDR underwent vitreous resection(PPV). The latter was randomly divided into the IVC&PPV group in which 15 patients(16 eyes)were treated with conbercept intravitreal injection in combination with vitrectomy and the PPV group in which 11 patients(12 eyes)underwent vitrectomy. Results: Among patients with NPDR, their diabetic retinopathy was improved in varying degrees,neovascularization was significantly inhibited, macular edema was improved and absorbed, and visual acuity was corrected in different degrees. IVC/PPV was significantly favorable for surgical operations. Conclusion: Intravitreal injection of Conbercept is an effective treatment for NPDR. For severe PDR patients who are undergoing vitrectomy, it can effectively reduce the difficulty of surgery and reduce the occurrence of surgical complications, so it is the mainstream choice for the treatment of diabetic retinopathy.
引文
[1]段直光,贾云琴,莫逆,等.贝伐珠单抗治疗糖尿病性黄斑水肿的疗效观察[J].大理大学学报,2016,1(4):55-59.
[2]DE SANCTIS V,INCORVAIA C,SOLIMAN A T,et al.Does Insulin Like Growth Factor-1(IGF-1)Deficiency Have a"Protective"Role in the Development of Diabetic Retinopathy in Thalassamia Major Patients[J].Mediterr JHematol Infect Dis,2015,7(1):132-138.
[3]GONZALEZ-SALINAS R,GARCIA-GUTIERREZ M C,GARCIA-AGUIRRE G,et al.Evaluation of VEGF gene polymorphisms and proliferative diabetic retinopathy in Mexican population[J].Int J Ophthalmol,2017,10(1):135-139.
[4]MARNEROS A G,FAN J,YOKOYAMA Y,et al.Vascular Endothelial Growth Factor Expression in the Retinal Pigment Epithelium Is Essential for Choriocapillaris Development and Visual Function[J].The American Journal of Pathology,2005,167(5):1451-1459.
[5]NGUYEN Q D,SHAH S M,VAN ANDEN E,et al.Supplemental oxygen improves diabetic macular edema:a pilot study[J].Invest Ophthalmol Vis Sci,2004,45(2):617-624.
[6]HUNG C C,LIN H Y,HWANG D Y,et al.Diabetic Retinopathy and Clinical Parameters Favoring the Presence of Diabetic Nephropathy could Predict Renal Outcome in Patients with Diabetic Kidney Disease[J].Sci Rep,2017,7(1):1236-1238.
[7]MAO C,YAN H.Roles of elevated intravitreal IL-1βand IL-10 levels in proliferative diabetic retinopathy[J].Indian J Ophthalmol,2014,62(6):699-701.
[8]王玲,杨丽萍,王大博,等.血清及房水白细胞介素-6水平与糖尿病性视网膜病变的相关性[J].中华实用诊断与治疗杂志,2014,28(12):1187-1189.
[9]金光明,朴莲善,田莲姬.NADPH氧化酶p22phox亚基基因多态性与糖尿病视网膜病变患者视网膜中央动脉血流动力学变化的关系[J].中国现代医学杂志,2014,24(25):26-29.
[10]辛月颖,袁凤山,旷劲松.糖尿病视网膜血流动力学及相关因素分析[J].中国现代药物应用,2013,7(21):24-26.
[11]LI X,XU G,WANG Y,et al.Safety and Efficacy of Conbercept in Neovascular Age-Related Macular Degeneration[J].Ophthalmology,2014,121(9):1740-1747.
[12]H?HN F,KRETZ F T,PAVLIDIS M.Primary vitrectomy with peeling of the internal limiting membrane under decaline:a promising surgical maneuver for treatment of total and subtotal retinal detachment[J].Ophthalmologe,2014,111(9):882-886.
[13]段直光,贾云琴,莫逆,等.Bevacizumab治疗视网膜静脉阻塞继发黄斑水肿的临床观察[J].国际眼科杂志,2014,14(9):1594-1598.
[14]徐冬君,戈伟中,李小东.康柏西普辅助玻璃体切除术治疗增生型糖尿病视网膜病变[J].实用医药杂志,2016,33(12):1092-1094.
[15]尹妮,赵帅,朱红娜.康柏西普和雷珠单抗联合玻璃体切除术治疗PDR的疗效比较[J].国际眼科杂志,2017,17(7):1300-1302.
[16]吴志勇,姚宜,闵云花,等.康柏西普辅助微创玻璃体切除术治疗增生性糖尿病视网膜病变的临床观察[J].临床眼科杂志,2017,25(2):141-144.
[17]李琴,王建宏,张明媚,等.23G玻璃体切割术前玻璃体腔注射雷珠单抗的临床观察[J].国际眼科杂志,2016,16(10):1959-1961.
[18]MORADIAN S,AHMADIEH H,MALIHI M,et al.Intravitreal bevacizumab in active prolififerative diabetic retinopathy[J].Arch Clin Exp Ophthalmol,2008,246(12):1699-1705.
[2]DE SANCTIS V,INCORVAIA C,SOLIMAN A T,et al.Does Insulin Like Growth Factor-1(IGF-1)Deficiency Have a"Protective"Role in the Development of Diabetic Retinopathy in Thalassamia Major Patients[J].Mediterr JHematol Infect Dis,2015,7(1):132-138.
[3]GONZALEZ-SALINAS R,GARCIA-GUTIERREZ M C,GARCIA-AGUIRRE G,et al.Evaluation of VEGF gene polymorphisms and proliferative diabetic retinopathy in Mexican population[J].Int J Ophthalmol,2017,10(1):135-139.
[4]MARNEROS A G,FAN J,YOKOYAMA Y,et al.Vascular Endothelial Growth Factor Expression in the Retinal Pigment Epithelium Is Essential for Choriocapillaris Development and Visual Function[J].The American Journal of Pathology,2005,167(5):1451-1459.
[5]NGUYEN Q D,SHAH S M,VAN ANDEN E,et al.Supplemental oxygen improves diabetic macular edema:a pilot study[J].Invest Ophthalmol Vis Sci,2004,45(2):617-624.
[6]HUNG C C,LIN H Y,HWANG D Y,et al.Diabetic Retinopathy and Clinical Parameters Favoring the Presence of Diabetic Nephropathy could Predict Renal Outcome in Patients with Diabetic Kidney Disease[J].Sci Rep,2017,7(1):1236-1238.
[7]MAO C,YAN H.Roles of elevated intravitreal IL-1βand IL-10 levels in proliferative diabetic retinopathy[J].Indian J Ophthalmol,2014,62(6):699-701.
[8]王玲,杨丽萍,王大博,等.血清及房水白细胞介素-6水平与糖尿病性视网膜病变的相关性[J].中华实用诊断与治疗杂志,2014,28(12):1187-1189.
[9]金光明,朴莲善,田莲姬.NADPH氧化酶p22phox亚基基因多态性与糖尿病视网膜病变患者视网膜中央动脉血流动力学变化的关系[J].中国现代医学杂志,2014,24(25):26-29.
[10]辛月颖,袁凤山,旷劲松.糖尿病视网膜血流动力学及相关因素分析[J].中国现代药物应用,2013,7(21):24-26.
[11]LI X,XU G,WANG Y,et al.Safety and Efficacy of Conbercept in Neovascular Age-Related Macular Degeneration[J].Ophthalmology,2014,121(9):1740-1747.
[12]H?HN F,KRETZ F T,PAVLIDIS M.Primary vitrectomy with peeling of the internal limiting membrane under decaline:a promising surgical maneuver for treatment of total and subtotal retinal detachment[J].Ophthalmologe,2014,111(9):882-886.
[13]段直光,贾云琴,莫逆,等.Bevacizumab治疗视网膜静脉阻塞继发黄斑水肿的临床观察[J].国际眼科杂志,2014,14(9):1594-1598.
[14]徐冬君,戈伟中,李小东.康柏西普辅助玻璃体切除术治疗增生型糖尿病视网膜病变[J].实用医药杂志,2016,33(12):1092-1094.
[15]尹妮,赵帅,朱红娜.康柏西普和雷珠单抗联合玻璃体切除术治疗PDR的疗效比较[J].国际眼科杂志,2017,17(7):1300-1302.
[16]吴志勇,姚宜,闵云花,等.康柏西普辅助微创玻璃体切除术治疗增生性糖尿病视网膜病变的临床观察[J].临床眼科杂志,2017,25(2):141-144.
[17]李琴,王建宏,张明媚,等.23G玻璃体切割术前玻璃体腔注射雷珠单抗的临床观察[J].国际眼科杂志,2016,16(10):1959-1961.
[18]MORADIAN S,AHMADIEH H,MALIHI M,et al.Intravitreal bevacizumab in active prolififerative diabetic retinopathy[J].Arch Clin Exp Ophthalmol,2008,246(12):1699-1705.