增生性糖尿病性视网膜病变玻璃体腔注射雷珠单抗后不同时间行玻璃体切割术疗效观察

The Effect of Vitrectomy Carried Out in Different Time after the Injection of Lucentis into the Vitreous Cavity for Proliferative Diabetic Retinopathy

目的：探讨增生性糖尿病视网膜病变（PDR）患者玻璃体腔注入雷珠单抗（Ranibizumab，Lucen-tis）后不同时间行玻璃体切割术治疗效果。方法对2012年5月～2013年11月确诊的PDR患者76例132眼，除外玻璃体积血眼底窥不清者，玻璃体腔注射Lucentis 0．5mg（0．05ml），据患眼注药后进行玻璃体切割手术的时间间隔不同分为A组25例（42眼）注药后3～6d、B组25例（44眼）注药后7～10d、C组26例（46眼）注药后11～15d。记录注药前后光学相干断层扫描（Optical Coherence Tomography，OCT）图像、眼底荧光血管造影（FFA）、手术时间及术后6个月最佳矫正视力。结果 A，B，C 3组注药后OCT显示黄斑区平均视网膜厚度（ CMT）明显降低（F＝6．60，P＜0．05），B，C两组明显优于A组（P＜0．05），但B，C间差别无统计学意义（P＞0．05）；眼底镜检查及眼底荧光血管造影检查可见视网膜新生血管减少或闭塞，荧光渗漏减少或消失，其中B，C两组优于A组（P＜0．05），手术时间及术后6个月视力B组优于A，C组（P＜0．05）。结论增生性玻璃体视网膜病变患者玻璃体腔注入抗血管生成药物雷珠单抗（Lucentis）7～10d后行玻璃体切割术术后效果最好。

Objective To abserve the effect of vitrectomy carried out in different time after the injection of Lucentis into the vit -reous cavity for proliferative diabetic retinopathy .Methods Seventy-six patients（132 eyes） with proliferative diabetic retinopathy （except pa-tients of vitreous haemorrhage with fundus could not be seen ） were injected Lucentis 0.5mg（0.05ml） into the vitreous cavity before vitrecto-my and were divided into three groups according to the different duration between the two kind of surgeries .Those were group A including 25 cases（42 eyes）,3 to 6 days before vitrectomy.group B including 25 cases（44 eyes）,7 to 10 days before vitrectomy and group C including 26 cases（46 eyes）,11 to 15 days before vitrectomy.Clinical indexes including Optical Coherence Tomography （OCT）,fluorescein fundus angiog-raphy（FFA）,operation time and visual acuity after 6 months were measured.Results Among all of the three groups ,the average central macular thickness was obviously decreased after injection .The difference was significant between group A ,group B and group C（F=6.60,P〈0.05）,but not significant between B and C （P〈0.05）.Fundus examination and FFA examination showed new blood vessels reduced or disappeared which were more obviously in group B and C （P〉0.05）.Operation time and 6 months best corrected visual acuity of group B were significantly better than group A and group C （P〈0.05）.Conlusion Vitrectomy of 7 to 10 days after the injection of Lucentis into the vitreous cavity for proliferative diabetic retinopathy gains the best outcome .