贝伐单抗辅助玻璃体切除术治疗增生性糖尿病视网膜病变

Pars Plana Vitrectomy Assisted by Bevacizumab for Proliferative Diabetic Retinopathy

目的:探讨玻璃体切割术前玻璃体腔注射贝伐单抗(Bevacizumab,Avastin)治疗糖尿病视网膜病变的临床应用价值。方法:选取我院收治的增生性糖尿病视网膜病变患者20例(20眼)分A,B两组,每组10例(10眼)。A组直接行玻璃体切割手术,B组于玻璃体切割术前玻璃体腔注射0.05 ml/1.25 mg Avastin。记录两组病例严重程度评分(complexity score,CS)评估其严重性。两组病例的平均CS为5.5,且两组的CS相近。记录两组患者手术时间及手术中的情况。结果:A组的手术时间为104 min,B组为72 min;术中发生严重出血需眼内电凝止血的病例A组6例,B组1例。B组病例在玻璃体腔注射Avastin后没有出现严重并发症。术后6个月B组病例视力有不同程度的提高,A组视力提高不明显,且B组病例10例均保持视网膜平伏,A组则是8例保持视网膜平伏,2例发生视网膜脱离。结论:在玻璃体切割术前玻璃体腔注射Avastin可以使新生血管消退,减少术中出血,易化手术过程,缩短手术时间,并且术后没有明显的并发症。

Objective： To evaluate the preoperative application of intravitreal bevacizumab （IVB） in patients undergoing pars plana vitrectomy （PPV） for proliferative diabetic retinopathy （PDR）. Methods： Twenty patients with PDR were involved in this study and a preoperative complexity score （CS） was recorded. Ten eyes were treated with 1.25 nag IVB for 7 days before PPV （group B）, and another 10 eyes underwent PPV （group A） without IVB treatment. The average CS was 5.5, and was similar in the two groups. Surgical time and intra-operative maneuvers were recorded. Results： Mean surgical time was 104 minutes in group A versus 72 minutes in group B; intraoperative bleeding cases were 6 versus 1, and endodiathermy cases were 6 versus 1. No complications were recorded after IVB. In the sixth month after the surgery, the visual acuity of group B had been improved, while that of group A had not. Anatomical attachment was achieved in 10 patients in group B versus eight patients in group A. Conclusion： IVB administered prior to vitrectomy is well tolerated and reduces active neovascularization, thus facilitates PPV procedures without increasing side effects.