白内障术后糖尿病黄斑水肿玻璃体内注射雷珠单抗的时机

The timing of intravitreal Ranibizumab therapy after cataract surgery in patient with diabetic macular edema

目的 探讨白内障术后不同时机使用雷珠单抗玻璃体内注射对糖尿病黄斑水肿（DME）的疗效.方法 DME合并白内障46例（46只跟）,随机分为观察组25例和对照组21例,两组均接受晶状体超声乳化人工晶状体植入术.观察组在术后即刻,对照组在术后4周分别给予0.5mg雷珠单抗玻璃体内注射.注射后观察最佳矫正视力（BCVA）、DME程度、黄斑厚度、眼压和血糖值.结果 超声乳化术前,两组平均BCVA（logMAR）分别为0.67±0.15,0.70 ±0.21（t=1.013,P＞0.05）,术后16周,观察组平均BCVA （logMAR）为0.45±0.35,优于对照组0.51±0.27（t=5.239,P＜0.05）.观察组和对照组的平均CRT分别由术前的（495.93±203.71） μm和（501.32±172.65）μm（t=1.727,P＞0.05）,减少为术后16周的（435.93±190.46）μm和（441.85±188.5）μm,并且术后观察组平均黄斑厚度少于对照组（=5.763,P＜0.05）.观察组和对照组经雷珠单抗注射后4周,DME患者的比例分别为80％和100％,观察组较对照组疗效更明显（x2 =4.712,P＜0.05）.两组患者雷珠单抗注射后,眼压都控制在10 ～ 21 mmHg,未发现其他重要的并发症.结论 DME患者在超声乳化术后,通过玻璃体内注射雷珠单抗,可有效地治疗DME,而超声乳化术后即刻行雷珠单抗注射,更有利于DME的治疗.

Objective To investigate the timing of intravitreal ranibizumab injection after phacoemulsification for the patients with diabetic macular edema （DME）.Methods Forty-six eyes of 46 patients with DME who underwent phacoemulsification surgery were randomly divided into observation group （n =25） and control group （n =21）.An intravitreal injection of ranibizumab （0.05 ml of solution at 10 mg/ml） was performed immediately after cataract surgery in the patients of observation group,and 4 weeks after surgery in control group.The main outcome measures included the best corrected visual acuity （BCVA）,central retina thickness （CRT）,macular edema grades,intraocular pressure （IOP） and blood sugar.Results Before phacoemulsification surgery,BCVA （logMAR） in observation group and control group were 0.67 ±0.15 and 0.70 ± 0.21 respectively （t =1.013,P 〉 0.05）.But 16 weeks after phacoemulsification surgery,the BCVA （logMAR） in observation group was 0.45 ± 0.35 which was better than that 0.51 ±0.27 in control group （t =5.239,P 〈 0.05）.The CRT in observation group and control group were changed from preoperative （495.93 ± 203.71） μm and （501.32 ± 172.65） μm to postoperative （435.93 ± 190.46） μm and （441.85 ± 188.54） μm,respectively.Meanwhile,CRT in observation group was better than that in control group after intraviteal ranibizumab injection.Comparing with that before injection,the percentage of DME patients was decreased to 80% in observation group,but it was unchanged in control group 4 weeks after intravitreal ranibizumab injection.No complication,such as endophthalmitis,retinal hemorrhage,retinal detachment,ocular hypertension or systemic thrombosis occurred in the patients of two groups after ranibizumab injection.Conclusion The treatment of intravitreal ranibizumab after phacoemulsification is effective for patients with DME and Ranibizumab injection should be performed after cataract surgery immediately,thus is better for DME treatment.