生蒲黄汤加减方对糖尿病性黄斑水肿术后的疗效及视网膜电图震荡电位的影响

Effects of modified Shengpuhuang Decoction Granules on diabetic macular edema after operation and its effect on electroretinogram shock potentialsv

目的:糖尿病性黄斑水肿(DME)患眼行玻璃体腔注射康柏西普及视网膜光凝治疗,术后予颗粒配方生蒲黄汤加减方治疗,观察其疗效及对视网膜电图震荡电位(ERG-OPs)波的影响。方法:将确诊为DME的患者56例(67眼)随机分为中药组和联合组各28例,中药组31眼,联合组36眼。67眼均接受玻璃体腔注射康柏西普后1~2周内进行视网膜光凝治疗。同时,眼内注射术后中药组给予颗粒配方生蒲黄汤加减方治疗3个月,联合组不予药物治疗。治疗过程中观察两组的疗效及在治疗1周、1个月、3个月时的最佳矫正视力(BCVA)、黄斑区视网膜厚度、ERG-OPs波振幅及潜伏期情况,并行安全性评估。结果:治疗3个月时,中药组总有效率优于同期联合组(P<0.05)。两组在1个月、3个月BCVA均高于本组治疗前(P<0.05);中药组BCVA总体高于联合组(P<0.05)。两组患者在治疗1周、1个月、3个月时黄斑区视网膜厚度均低于本组治疗前(P<0.05)中药组O1、O3波峰潜伏期治疗后较本组治疗前与联合组同期均显著缩短(P<0.05)。两组患者在1~3个月过程中再次行眼内注射药物康柏西普情况:中药组为5眼,联合组为8眼。眼内注射及光凝术安全性高,术后仅见3例球结膜下出血,其余未见其它不良反应发生。结论:DME经玻璃体腔注射康柏西普及视网膜光凝治疗后,黄斑水肿明显减轻,手术安全性高;辅助中药颗粒配方治疗比单纯联合治疗更能促进视网膜水肿、出血、渗出吸收,同时延缓黄斑水肿复发,并改善视网膜功能。

Objective:Diabetic macular edema(DME)eye was treated with intravitreal injection of Conbercept and retinal photocoagulation therapy.After treatment,modified Shengpuhuang Decoction Granules was given to observe the effect of shock potentials(OPs)on the electroencephalogram(ERG).Methods:Fifty-six patients(67 eyes)diagnosed with DME were randomly divided into 28 cases of Chinese medicine group and combined group,31 eyes of Chinese medicine group and 36 eyes of combined group.Sixty-seven eyes were received intravitreal injection of Conbercept 1 to 2 weeks after retinal photocoagulation treatment.At the same time,after intravitreal injection,Chinese medicine group was given modified Shengpuhuang Decoction Granules for 3 months,while combined group was given no drug treatment.The efficacy of the two groups was observed during the treatment and the best corrected visual acuity(BCVA),macular retinal thickness,ERG-OPs wave amplitude and latency were observed at 1 week,1 month and 3 months.Results:After 3 months treatment,the total effective rate of Chinese medicine group was better than that of the combined group,and the difference was statistically significant(P<0.05).After 1 month and 3 months treatment,BCVA was significantly higher than that before treatment in the two groups(P<0.05).And the BCVA of Chinese medicine group was higher than that of the combined group,and there was significant difference(P<0.05).The thickness of retina in the macular area was lower than that before treatment(P<0.05)at 1 week,1 and 3 month.The latency of O1 and O2 in ERGOPs was significantly shorter than that before treatment,and the latency of O1 peak in the combined group was significantly longer than that before treatment(P<0.05).Two groups of patients in the course of 1~3 mo were given intraocular injection of Conbercept again.The Chinese medicine group was 5 eyes,and the combined group was 8 eyes.Intraocular injection and photocoagulation were safe,and only 3 cases of postoperative subconjunctival hemorrhage occurred,with no other adverse reaction.Conclusion:After DME treated by intravitreal injection of Conbercept and retinal photocoagulation treatment,macular edema was significantly reduced,with high operation safety.Compared to simple combination therapy,combined modified Shengpuhuang Decoction Granule can promote retinal edema,bleeding,oozing absorption,while delay the recurrence of macular edema,and improve the role of retinal function.