应用雷珠单抗并23G玻璃体切割术治疗糖尿病视网膜病变术前术后对比分析

Comparative study of different time intraVitreal ranibizumab assisted 23G vitrectomy for diabetic retinopathy

目的探讨术前或手术结束时应用雷珠单抗玻璃体腔注射联合23G玻璃体切割术对增殖型糖尿病性视网膜病变术中和术后并发症的影响。方法前瞻性对照研究。回顾性分析哈尔滨市眼科医院在2014年9月至2015年6月收治的28例23G玻璃体切割术治疗增殖型糖尿病视网膜病变患者，其中12例玻璃体切割术前一周给予玻璃体腔注射雷珠单抗0．05mL（A组），16例行23G玻璃体切割术完毕时玻璃体腔注射雷珠单抗0．05mL（B组）。比较两组患眼术中出血，手术时间，术后再出血及视力的差异。结果平均手术时间A组为（56．58±7．05）min，B组为（67．63＋9．47）min，差异有统计学意义（t=3．4，P=0．002），A组的手术时间明显少于B组；手术中对增殖膜的处理A组也较B组难度低；术中A组由于撕膜引起的较大量出血为4例（4／12），B组为8例（8／16），差异有统计学意义（P=O．024）。术后随访一个月内，A组有2例（2／12）出现再出血，出血均在半月内吸收，视网膜均平伏；B组再出血为5例（5／16），差异无统计学意义（P〉0．05）；随访半年A组再出血为3例（3／12），B组未再出血，差异有统计学意义（P=0．035）。术后视力：两组间没有明显差异，均较术前明显提高，差异有统计学意义（P=0．044）。结论23G玻璃体切割术前注射雷珠单抗可以缩短手术时间，降低增殖型糖尿病视网膜病变玻璃体手术难度和减少短期术后出血发生率；术后应用雷珠单抗玻璃体腔注射可以减少术后远期再出血发生率，也可以促进术后再出血的吸收，提高术后视力。

Objective To discuss the influence of 23G vitrectomy assisted with preoperative or postoperative intravitreal ranibizumab for proliferative diabetic retinopathy. Methods A retrospective analysis of 28 eyes with proliferative diabetic retinopatby treated by 23G vitrectomy from September 2014 to June 2015 was performed. Twelve eyes treated by 23G vitrectomy assisted with preoperative intravitreal injection of ranibizumab as injected group （group A）, 16 eyes treated by 23G vitrectomy assisted with postoperative intravitreal injection of ranibizumab as injected group （group B）. The oper- ative time, hemorrhage during the operation, postoperative complications and postoperative visual acu- ity between the two groups were compared. Results The operation time in group A was （56.58±7.05） minutes, group B was （67.63±9.47） minutes, the difference was statistically significant （P 〈 0.05）. Hemorrhage during the operation was observed in 4 eyes in group A and 8 eyes in group B. In postoperative follow-up period, there were 2 cases re-bleeding in the group A, and 5 eyes in the group B within a month; there was 3 cases re-bleeding in the group A, but there was no one eyes in the group B within six months. The postoperative visual acuity in group A and B was not statisti- cally significant, but the difference was statistically significant （P 〈0.05） between preoperative andpostoperative. Conclusions 23G vitrectomy assisted with preoperative intravitreal injection of ranibizumab can decrease the operation time, reduce the incidence of intraoperative and postoperative intravitreal injection of ranibizumab can decrease the postoperative complica- tions in the treatment of proliferative diabetic retinopathy.