虹膜红变糖尿病视网膜病变雷珠单抗眼内注射后玻璃体切除术的体会

The experience of vitrectomy for diabetic retinopathy with rubeosis iridis after intravitreal injection of ranibizumab

目的 探讨伴有虹膜红变的增生性糖尿病视网膜病变（PDR）于玻璃体内注射雷珠单抗（ranibizumab）后进行玻璃体切除术的临床效果.方法 对伴有虹膜红变的PDR 20例（26只眼）的病例资料进行回顾性分析.患者均伴有不同程度的玻璃体积血和（或）牵引性视网膜脱离,在雷珠单抗玻璃体内注射3～7 d后进行非接触广角镜下玻璃体切除术.观察虹膜新生血管（INV）的变化情况,记录玻璃体切除术手术历时、术中和术后出血情况,以及术后视力等.结果 玻璃体内注药后,22只眼（84.62％） INV明显消退,其余4只眼（15.38％）无明显变化.4例4只眼未行玻璃体切除术.20例22只眼玻璃体切除术手术历时（71.13 ±9.52） min,4只眼（18.18％）术中发现牵引性视网膜裂孔,剥除视网膜前增生膜视网膜未完全复位,行硅油填充.术后3d时2只眼（9.09％）出现玻璃体积血,经保守治疗后吸收.术后3个月视力较术前明显提高者17只眼（77.27％）,无变化者5只眼（22.73％）.结论 玻璃体内注射雷珠单抗可使PDR虹膜新生血管明显消退;并能减少术中出血,缩短手术时间.伴虹膜红变的PDR雷珠单抗玻璃体内注射后非接触广角镜下玻璃体切除术可以取得较好的临床效果,扩大了PDR玻璃体切除术适应证的范围.

Objective To investigate the clinical effect of vitrectomy for proliferative diabetic retinopathy （PDR） with rubeosis iridis after intravitre、al injection of ranibizumab.Methods The data of 26 eyes of 20 patients of PDR with rubeosis iridis were retrospectively analyzed.All patients had vitreous hemorrhage and/or tractional retinal detachment.Intravitreal injection of ranibizumab was performed 3 to 7 days before vitrectomy with non-contact wide angle lenses.The changes of iris neovascularization （INV）,operation time,hemorrhage during and after surgery,and postoperative visual acuity were analyzed.Results After the intravitreal injection,INV regressed in 22 eyes （84.62%）,and there was no change in 4 eyes （15.38%）.Vitrectomy had not been performed on these 4 eyes of 4 patients.Mean operation time of 22 eyes of 20 patients was （71.13 ±9.52） min.Tractional retinal holes were found in 4 eyes （18.18%）,in which silicone oil were used.The hemorrhage occurred in 2 eyes （9.09%） 3 days after operation,and was absorbed after conservative treatment.At 3 months after surgery,the visual acuity was improved in 17 eyes （77.27%）,and remained unchanged in 5 eyes （22.73%）.Conclusion Intravitreal injection of ranibizumab is an effective treatment for PDR with rubeosis iridis.Ranibizumab can reduce iris neovascularization and intraoperative hemorrhage,and shorten the operation time.Vitrectomy with noncontact wide angle lenses after intravitreal injection of ranibizumab for PDR with rubeosis iridis can obtain a better clinical effect,and expand ranges of vitrectomy indications.