摘要
背景玻璃体切割手术是目前治疗增生性糖尿病视网膜病变（PDR）的主要方法，但其主要术后并发症为眼内再出血。雷珠单抗是目前常用的抗血管内皮生长因子药物，但其与玻璃体切割术联合疗法是否能够降低PDR术后再出血的发生率有待研究。目的探讨PDR患者行25G玻璃体切割手术前玻璃体腔注射雷珠单抗的疗效及其是否可防止术后再出血。方法采用回顾性队列研究设计，纳入2014年1月至2015年7月于北京大学国际医院眼科诊断为Ⅴ-Ⅵ期PDR并接受玻璃体切割术患者60例66眼的临床资料，按照患者接受的手术方法不同将患者分为单纯手术组和药物联合手术组，单纯手术组49例34眼，接受25G玻璃体切割手术，药物联合手术组25例32眼，先行0．05ml（0．5mg）雷珠单抗玻璃体腔注射，并于注射后1周行25G玻璃体切割手术。分别于术后1d、1周、1个月和3个月检查和比较2个组术眼的视力；观察和比较2个组术后1d、3～7d和术后1个月术眼眼底再出血的发生率。结果药物联合手术组术后1d、1周、1个月和3个月不同等级视力的眼数和百分数与单纯手术组比较差异均无统计学意义（Z=0．673，P=0．412；Z=0．113，P=0．737；Z=1．755，P=0．185；Z=2．474，P=0．i16）；注药联合手术组术后1d和3—7d眼内再出血者分别为1眼，而单纯手术组分别为9眼，组间比较差异均有统计学意义（均P〈0．05）；注药联合手术组术后≥1个月无眼内再出血者，而单纯手术组为4眼。结论PDR患者行25G微创玻璃体切割手术前1周行玻璃体腔雷珠单抗注射可有效降低术后眼内再出血的发生率。
Background Vitrectomy is a primary approach to the treatment of proliferative diabetic retinopathy （PDR）. However, postoperative rehaemorrhagia often occur. Ranibizumab is an effective drug of antivascular endothelial growth factor,but whether the combination of intravitreal injection of ranibizumab with vitreetomy can reduce the incidence of postoperative rehaemorrhagia in PDR patients is still unclear. Objective This study was to investigate the preventive effect of the combination of intravitreal injection of ranibizumab with 25-gauge vitrectomy on postoperative rehaemorrhagia. Methods A retrospective cohort study was perfomed. The clinical data of Ⅴ-Ⅵ stage of PDR patients who received 25-gauge vitrectomy in Peking University International Hospital from January 2014 to July 2015 were collected and analyzed. The PDR patients were divided into only surgery group and drug with surgery group. The patients in the only surgery group （34 eyes of 49 patients ） received 25-gauge vitrectomy, and the patients in the drug with surgery group （32 eyes of 25 patients） received the intravitreal injection of ranibizumab 0. 05 ml （0.5 mg） 7 days before 25-gauge vitrectomy. The distribution of eye number in different grades of visual acuities was observed and compared between the two groups in 1 day, 1 week,1 month and 3 months after surgery,and the incidence of rehaemorrhagia was intergrouply compared in 1 day,3-7 days and 1 month after surgery. Results The eye number and percentage of the different visual acuities in the drug with surgery group was not significantly different from the only surgery group in 1 day,1 week, 1 month and 3 months after surgery （ 1 day： Z=0.673,P=0.412;1 week：Z=0.113,P=0.737;1 month：Z= 1.755,P=0.185;3 months：Z= 2.474,P= 0. 116）. Rehaemorrhagia occurred in postoperative day 1 and day 3-7 was 1 eye and 1 eye respectively in the drug with surgery group, and that in the only surgery group was 9 eyes and 9 eyes respectively, showing significant difference between the two g
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2017年第1期69-72,共4页
Chinese Journal Of Experimental Ophthalmology
