术前玻璃体腔内注射抗VEGF对增殖性糖尿病性视网膜病变行玻璃体术的影响研究

Influence of Chamber in Jection with Anti- Vegf on Vireous Surgery for Proliferative Diabetic Retinopathy Membrane

目的:探讨术前玻璃体腔内注射抗VEGF制剂对增殖型糖尿病性视网膜病变行玻璃体手术的影响。方法:选取2011年4月—2014年10月我院收治的增殖型糖尿病性视网膜病变患者40例为研究对象,随机将其分为:对照组(20例)、观察组(20例)。对照组采用玻璃体术进行治疗,观察组术前先行玻璃体腔注射抗VEGF制剂,再采用玻璃体术进行治疗。比较两组患者的增殖膜标本显微镜下观察结果、新生血管及原始组织细胞、血管内皮细胞数目。结果:1显微镜观察结果:对照组患者增殖膜表面有新生血管芽生成,增殖膜内的新生血管由多层内皮细胞环绕而成,内皮细胞呈圆形,细胞核质疏松,部分可见深染核仁,观察组患者增殖膜内基质成分增加,膜内新生血管呈不规则状,由单层内皮细胞环绕而成,内皮细胞呈细长形,细胞核较小,呈椭圆形,深染未见核仁;增殖膜内出现大量类圆形结构的异物巨细胞,细胞核较大,为椭圆形,部分淡染可见核仁;2各观察指标情况:实验组的新生血管、原始组织细胞及血管内皮细胞数目明显低于对照组,P<0.05,差异有统计学意义。结论:术前玻璃体腔注射抗VEGF制剂,不仅能够有效抑制增殖型糖尿病性视网膜病变患者视网膜新生血管的生成,还可降低视网膜新生血管数目,从而使术中及术后出血量降低,提升玻璃体术成功率。

Objective： To study the influence of vitreous chamber injection with anti- VEGF on vitreous surgery for proliferative diabetic retinopathy membrane. Method： During April 2011 to April 2014,40 cases of patients with proliferative diabetic retinopathy were selected and they were divided into two groups： the trial group and the control group,each group consist of 20 cases. The control group were treated by vitreous surgery,the trial group were first treated by preoperative vitreous chamber injection of anti- vascular endothelial growth factor（ anti- VEGF） agents,and then treated by vitreous surgery. Comparison of two groups with the observation results for proliferative membrane specimens under the microscope,neovascularization,number of original tissue cells and vascular endothelial cells. Results： ①Observation results under the microscope showed that the neovascularization bud grew on the surface of proliferative membrane in the control group and inside the proliferative membrane was neovascularization surrounded by multilayer endothelial cells. The cell nucleo- cytoplasm was loose and dark stained nucleolus was partially visible. Matrix components increased in proliferative membrane in the trail group,neovascularization inside the membrane had a irregular shape and was surrounded by monolayer endothelial cells. The endothelial cells were elongated,nuclear was small and oval,no nucleoli in the deep staining region. A large number of circular structure of foreign body giant cells appeared in the proliferation membrane. The nucleus was relatively large,oval,nucleolus can be seen in some light staining region; ②Observation index： The number of neovascularization,original tissue cells and vascular endothelial cell in the trial group was significantly lower than that in the control group,P 〈0. 05,the difference had statistical significance. Conclusion： Preoperative injection of anti- VEGF in vitreous chamber not only can effectively inhibit the formation of neovascularization in patients with proliferative diabetic retinopathy proliferation membrane,but also can reduce the number of retinal neovascularization. Thus reducing the amount of bleeding during intraoperative and postoperative,enhance the success rate of vitreous surgery.