conbercept眼内注射联合23G微创玻璃体手术治疗增生性糖尿病视网膜病变的疗效观察

Application of intravitreal conbercept combined by 23-gauge micro-invasive vitrectomy in proliferative diabetic retinopathy

目的观察conbercept眼内注射后再行23G微创玻璃体切除治疗增生性糖尿病视网膜病变(PDR)的效果。方法 PDR患者共24例(24只眼),观察组12只眼,玻璃体腔注射conbercept 0.5 mg(0.05ml)3~7 d后行23G微创玻璃体切除术,对照组12只眼,行常规20G玻璃体切除术。对比两组术后最佳矫正视力log MAR BCVA、手术时间、医源性裂孔发生率、电凝使用次数、术后并发症情况。结果随访两组术后6个月平均log MAR BCVA分别为观察组(0.47±0.17)和对照组(0.33±0.16)(P<0.05).观察组平均手术时间为(46.35±18.37)min,而对照组为(66.12±23.63)min(P<0.05).医源性裂孔在观察组中有1例,占8.33%,而对照组中有3例,占25.0%(P<0.05).在观察组术中有4例使用电凝,占33.33%,对照组为8例,占66.67%(P<0.05),观察组有1例出现术后复发玻璃体积血,占8.33%,对照组为3例,占25.0%(P<0.05).观察组有2例出现术后高眼压,占16.67%,对照组为4例,占33.33%观察组3例术后角膜水肿,占25.0%,对照组为7例,占58.33%.结论术前眼内注射conbercept联合23G微创玻璃体切除治疗PDR可以显著提高术后视力,缩短手术时间、减少医源性裂孔发生、降低手术难度、提高手术质量。

Objective To observe the effect of preoperative intravitreal conbercept injection before 23 G pars plana vitrectomy（ PPV） for proliferative diabetic retinopathy. Methods To retrospect and study the cases. 24 patients 24 eyes with severe proliferative diabetic retinopathy who were divided into drug group and control group. Main outcomes measures were log MAR BCVA,incidence of iatrogenic retinal breaks,endodiathermy times,the number of bleeding in operation and postoperative. Results At 6 months after surgery,the average log MAR BCVA of the drug group and control group was respectively（0. 47 ± 0. 17） and（0. 33 ± 0. 16）,the visual acuity of both group improved significantly（ P 0. 05）. Iatrogenic retinal breaks were reported in 1 cases（ 8. 33%） in drug group and 3 cases（ 25. 0%） in control group（ P 0. 05）. The number of bleeding in operation was reported in 4 cases（33. 33%） in drug group while 8 cases（ 66. 67%）were reported in control group（ P 0. 05）. intraocular hypertension was reported in 3 cases（ 16. 67%） in drug group while 4 cases（33. 33%） were reported in control group（ P 0. 05）. Conclusions intravitreal conbercept for Proliferative diabetic retinopathy before 23-gauge micro-invasive vitrectomy had a significan effect,It can obviously improve visuaacuity,reduce the incidence of iatrogenic retinal break,the number of bleeding in operation and postoperative,and reduce the difficulty and the incidence of surgical complications.