玻璃体腔注射Avastin在晚期增生性糖尿病视网膜病变术中应用分析

Pars Plana Vitrectomy Assisted with Avastin for Proliferative Diabetic Retinopathy

目的探讨玻璃体腔注射Avastin对晚期增生性糖尿病视网膜病变手术难度的改善、术中眼内填充的选择、手术并发症的发生及疗效情况。方法2008年7至12月，对晚期增生性糖尿病视网膜病变的病人38例38只眼术前先行玻璃体腔注射Avastin0．06ml（注射组），然后行手术治疗。选择2008年1至6月未进行玻璃体腔注射Avastin的晚期增生性糖尿病视网膜病变的病人47例47只眼作对照（非注射组）。观察：（1）注射组与非注射组患者手术中出血情况，医源性裂孔发生率及增殖膜剥除的彻底性；（2）术中需要行硅油填充的比例；（3）术后再出血、再增殖等的发生情况；（4）手术后病人的视力。结果注射组较大量出血2只眼，5.3％；非注射组20只眼，42．6％（P〈0．05）。注射组医源性裂孔3只眼，6．4％；非注射组12只眼，25．5％（P〈0．05）。注射组增殖膜都能彻底剥除，非注射组4只眼进行膜分割，有膜蒂残留。注射组术中2只眼需要硅油填充，5．3％，非注射组11只眼需要硅油填充，23．4％（P〈0．05）。注射组术后有1只眼出现Ⅲ级玻璃体反应，非注射组有4只眼。随访期内，注射组没有再出血的病例，非注射组再出血6只眼，12．8％。注射组术后没有再增殖的病例，非注射组有2只眼因再增殖需再次手术治疗。术后视力注射组为光感至0．2，非注射组为光感至0．1，两组间差异没有统计学意义，但注射组和非注射组术前术后视力均有统计学差异，其P值分别为0．043和0．046。结论在晚期增生性糖尿病视网膜病变手术前玻璃体腔注射Avastin，能有效控制手术中的出血、膜剥离不彻底、医源性裂孔等并发症的发生，减少硅油填充的比例，减少术后玻璃体再出血及增殖，大大降低了手术的风险，提高了手术的成功率。

Objective To evaluate the efficacy ofvitrectomy assisted with preoperative intravitreal injection of Avastin for severe proliferative diabetic retinopathy.Methods Thirty-eight cases （thirty-eight eyes） with severe proliferative diabetic retinopathy were treated by vitrectomy assisted with preoperative inteavitreal injection of Avastin.Forty-seven cases （forty-seven eyes） with severe proliferative diabetic retinopathy treated by vitrectomy were analyzed as control group.Hemorrhage during the operation, risks of iatrogenic hole, percentage of silicone oil tamponade, rebleeding and proliferation postoperative and visual acuity postoperative were observed.Results Obvious hemorrhage during the operation were observed in 2 eyes in the Avastin group（5.3% ） and 20 eyes in the control group（42.6% ）（P〈0.05 ）.The risk of iatrogenic hole of Avastin group and control group were 6.4% （3 eyes） and 25.5%（ 12 eyes） respectively. （P〈0.05）.The proliferative membrane of the Avastin group was more easily removed than that of the control group.Two eyes of the Avastin group and eleven eyes of the control group needed silicon oil tamponade.There were no cases rebleeding postoperative in the Avastin group but there were six eyes rebleeding in the control group.Two eyes of the control group proliferated again postoperatively and needed vitrectomy once more.The visual acuity postoperative of Avastin group and the control group were LP-0.2 and LP-0.1 respectively.There was no statistic difference during the two groups.Conclusion Vitrectomy assisted with preoperative intravitreal injection of Avastin was benefic for severe proliferative diabetic retinopathy.