玻璃体腔注射ranibizumab对增殖性糖尿病视网膜病变微创玻璃体视网膜手术影响

The effect of intravitreal ranibizumab to microincision vitreoretinal surgery for proliferative diabetic retinopathy

目的观察手术前玻璃体腔注射抗血管内皮生长因子（VEGF）单克隆抗体ranibizumab（IVR）对严重增殖性糖尿病视网膜病变（PDR）微创玻璃体视网膜手术（VRS）的影响。方法采用回顾性非随机临床对照研究。对2012年8月至2013年12月在天津市眼科医院临床确诊为严重PDR的81例100只眼纳人研究。依据术前是否行IVR将患者分为IVR组和对照组。IVR组41例50只眼，对照组40例50只眼。IVR组于手术前3～4d行玻璃体腔注射10mg／ml的ranibizumab0．05ml（含ranibizumab0．5mg），然后行23G微创VRS。对照组直接行23G微创VRS。对比分析：两组平均手术时间、新生血管出血平均次数、电凝使用平均次数、平均器械交换次数、医源性视网膜裂孔发生率、视网膜切开率。结果IVR组患者注药后均未发生与药物相关的局部及全身不良反应。IVR组、对照组平均手术时间分别为（87．43±29．34）、（100．86±17．21）min，差异具有统计学意义（t=-2．34，P〈0．05）。IVR组、对照组术中新生血管出血平均次数分别为（0．66±0．72）、（1．44±1．23）次，差异具有统计学意义（t=-4．13，P〈0．05）；IVR组、对照组术中电凝使用平均次数分别为（0．30±0．58）、（0．82±0．94）次，差异具有统计学意义（t=-3．33，P〈0．05）。IVR组、对照组术中平均器械交换次数分别为（15．28±5．35）、（23．47±7．32）次，差异具有统计学意义（t=4．56，P〈0．05）。IVR组、对照组术中医源性视网膜裂孔发生率分别为2％、16％，差异具有统计学意义（r=5．98，P〈0．05）。IVR组、对照组术中视网膜切开率分别为14％、32％，差异具有统计学意义（r=4．57，P〈0．05）。结论手术前IVR能够有效地易化PDR患者VRS，并且降低手术中并发症的发生率。

Objective To observe the effect of intravitreal anti-vascular endothelial growth factor （VEGF） monoclonal antibody ranibizumab （IVR） as a preoperative adjunct in microincision vitreoreti- nal surgery （VRS） for severe proliferative diabetic retinopathy （PDR）. Methods A prospective non-randomized controlled clinical study. A total of 81 patients （100 eyes） with severe PDR diag- nosed were enrolled and divided into IVR group （41 patients, 50 eyes） and control group （40 pa- tients, 50 eyes）. IVR group patients received an intravitreal injection of 0.05ml ranibizumab solution （10mg/ml） first, and 3 or 4 days later they received 23G microincision VRS. Control group patients only received 23G microincision VRS. The surgical mean time, the mean number of hemorrhage in retinal neovascularization, the mean number of endodiathermy, the mean tool exchanges, the inci- dence of iatrogenic retinal breaks, and the incidence of relax retinotomy were comparatively ana-lyzed. Results There was no topical and systemic adverse reactions associated with the drug after injection in IVR group. The surgical mean time of IVR group [（87.43±29.34） min] was shorter than that of control group [（100.86±17.21） min], the difference was statistically significant （t =-2.34, P 〈 0.05）. The mean number of hemorrhage in retinal neovascularization of IVR group （0.66±0.72） was shorter than that of control group （1.44±1.23）, the difference was statistically significant （t =-4.13, P 〈0.05）. The mean number of endodiathermy of IVR group （0.30±0.58） was shorter than that of control group （0.82＋0.94）, the difference was statistically significant （t =-3.33, P 〈0.05）. The mean tool exchanges of IVR group （15.28±5.35）was shorter than that of control group （23.47±7.32）, the difference was statistically significant （t =4.56, P 〈0.05）. The incidence of iatrogenic retinal breaks in IVR group （2%） was lower than that in control group （16%）, the difference was statistically sig- nificant （t =4.40, P 〈0.05）. The incidence of relax retinotomy in IVR group （14%） was lower than that in control group （32%）, the difference was statistically significant （t =4.57, P 〈0.05）. Conclusions IVR as a preoperative adjunct in vitrectomy can make the surgery easier for PDR which achieves lower incidence of intraoperative complications.