联合抗VEGF药物激光治疗糖尿病视网膜病变对预后的影响分析

Prognosis Effect Analysis of Joint Treatment of VEGF with Laser on Diabetic Retinopathy

观察抗血管内皮生长因子(VEGF)药物联合激光治疗重度非增殖性糖尿病视网膜病变与传统激光治疗对患者视力及预后的影响.临床病例对照方法研究,对2012年2月至2015年8月在云南省第一人民医院眼科选取经FFA和OCT检查确诊的重度非增殖期糖尿病视网膜病变患者79例158眼.根据自愿原则,选取玻璃体腔穿刺注射雷珠单抗联合全视网光凝者为治疗组,常规PRP者为对照组.分析两组治疗后第1周、第2周、第4周,第2月、第3月、第6月、第9月、第12月视力,黄斑中心视网膜厚度、视网膜血管改变、玻璃体腔等情况.结果表明:两组治疗前有很好的可比性,年龄、视力、黄斑视网膜厚度两组间差异无统计学意义(P<0.05),治疗组在术后第2周、第4周、第2月、第3月、第6月、第12月视力、黄斑视网膜厚度均较对照组有明显改善,12月内视网膜血管改变,玻璃体腔积血、增殖者两组间差异有统计学意义.通过1年的临床观察行玻璃体腔注射抗VEGF药物,同时联合PRP治疗可有效提高患者中心视力,减轻黄斑部水肿,降低玻璃体积血及视网膜新生血管的发生率.

The effects of joint treatment of VEGF（ vascular endothelial growth factor） with laser versus traditional laser therapy on vision and prognosis of the patients with diabetic retinopathy are compared in this study. Based on the clinical case-control study,158 eyes of 79 patients who were confirmed by OCT and FFA with severe nonproliferlative diabetic retinopathy in the First Pepole＇s Hospital of Yunnan Province,between Feb. 2012 to Aug. 2015 are chosen. According to the voluntary principle,vitreous cavity injection anti-VEGF joint panretinal photocoagulation is established as the treatment group,while traditional panretinal photocoagulation as the control group. Analysis is carried out in the two groups on visual acuity,center thickness of macular,changes in retinal blood vessels,vitreous hemorrhage on 1w,2w,4w,2m,3m,6m,9m,12 m and 24 m after treatment. The two groups before treatment has good comparability with age,visual acuity and macular thickness,and there is no statistically significant difference between the two groups. The visual acuity and macular thickness of the treatment group are obviously improved than the control from 2w to 12 m after treatment. From 12 m to 24 m,the differences between the two groups have statistical significance. Through clinical observation for a year,vitreous cavity injection anti-VEGF joint panretinal photocoagulation is proved to improve effectively visual acuity. In the meantime,it reduces macular edema,the risk of vitreous hemorrhage and the occurrence of retinal neovascularization.