增殖性糖尿病视网膜病变玻璃体切除术前注射雷珠单抗与曲安奈德疗效对比研究

Efficacy comparison between injection of intravitreal ranibizumab and triamcinolone as a preoperative adjunct before vitrectomy surgery for proliferative diabetic retinopathy

目的对比观察增殖性糖尿病视网膜病变（PDR）患者玻璃体切除术（PPv）前玻璃体腔注射雷珠单抗（Ranibizumab，Lucentis）与曲安奈德（triamcinolone，TA）的临床疗效。方法临床病例对照研究。选取2014年3月至2015年9月在郑州大学第一附属医院眼科住院确诊为PDR并行PPV治疗的61例78只眼为研究对象。PPV术前注射Lucentis者33例42只眼（Lucentis组），注射TA者28例36只眼（TA组）。对比两组PPV手术时间、是否使用电凝及填充物，记录随访过程中患者视力恢复、复发出血、眼压及黄斑中心凹网膜厚度等情况。结果Lucentis组手术时间（46．95±18．16）min显著低于TA组（66．42±17．76）min，差异有统计学意义（t=-4．767，P=0．000）。Lucentis组术中出血严重需使用电凝者（3只眼）较TA组（11只眼）明显下降，差异有统计学意义（x^2=7．215，P=0．009）。两组患者随访3月最佳矫正视力（BCVA）均较术前显著提高，差异有统计学意义（t=6．557，5．837；P=0．000，P=0．000），但两组间硅油填充率、复发出血、眼压、黄斑中心凹网膜厚度均无统计学意义（均为P〉0．05）。结论PDR患者PPV术前玻璃体腔注射Lucentis与TA均安全有效，Lucentis较TA显著减少术中出血，降低电凝使用率、缩短手术时间，提高PDR患者PPV治疗效果。

Objective To observe the differences between intravitreal injection of ranibizumab （Lucentis） and triamcinolone （TA） before vitrectomy surgery in the treatment of proliferative diabetic retinopathy （PDR）. Methods A total of 61 patients （78 eyes） with PDR diagnosed in our clinic from March 2014 to September 2015 were enrolled and divided into Lucentis group （33 patients, 42 eyes） and TA group （28 patients, 36 eyes）. Lucentis group patients received an intravitreal injection of Lucentis before pars plana vitrectomy （PPV）, TA group patients received an intravitreal injection of TA. The average operation time, the use of filler and electric coagulation, the change of best corrected visual acuity （BCVA）, postoperative bleeding, intra-ocular pressure （lOP） and central macular thickness （CMT） were comparatively analyzed between the two groups. Results The operation time in the Lueentis group was （46.95±18.16）min, while in the TA group was （66.42±17.76）min, the difference was statistically significant （t =-4.767, P =0.000）. Three eyes needed electric coagulation in Lucentis group, eleven eyes in TA group, and the difference was statistically significant （x^2=7.215, P = 0.009）. The mean 3 months after surgery logMAR BCVA of Lucentis group and TA group had both improved than their preoperative BCVA （t =6.557, 5.837; P =0.000, P =0.000）. The differences of oil silicone use, postoperative bleeding, IOP and CMT between two group were not statistically significant （P 〉0.05）. Conclusions The intravitreal injection of Lueentis and TA before the vitrectomy surgery for PDR are both effective. Lucentis can more significantly decrease intraoperative hemorrhage, reduce electric coagulation, and shorten the operation time, improve the effects of PPV in PDR patients.