Ranibizumab玻璃体腔注射辅助玻璃体切割术治疗PDR合并NVG的临床观察

Clinical Observation of Intravitreal Ranibizumab Combined with Virectomy in the Treatment of PDR Combined NVG

目的探讨Ranibizumab(雷珠单抗)玻璃体腔注射辅助玻璃体切割术对增殖性糖尿病视网膜病变(PDR)合并新生血管性青光眼(NVG)的临床效果。方法对我院眼科2013年5月—2016年2月诊治的PDR合并NVG的53例患者(53只眼)的临床资料进行回顾分析,在患者知情同意的情况下,将患者按照不同的治疗方法分为观察组和对照组,其中28例(28只眼)在玻璃体切割术前行玻璃体腔注射Ranibizumab作为观察组,25例(25只眼)只行玻璃体切割作为对照组。观察记录患者的术中及术后情况,并进行组间对比分析。结果与对照组比较,观察组患者的手术时间显著缩短,且切割术中新生血管出血的次数、器械交换次数和电凝次数均显著少于对照组,差异有统计学意义(P<0.05);术中观察组出血、医源性视网膜裂孔及纤维血管残留发生率均低于对照组,其中两组轻度出血发生率差异有统计学意义(P<0.05);术后一个月,观察组CRT显著低于对照组,BCVA显著高于对照组(P<0.05);术后一周两组眼压较术前显著升高,对照组变化尤为显著,术后一个月两组眼压均有所降低,其中观察组显著低于对照组(P<0.05),但两组与术前比较差异无统计学意义(P>0.05);术后观察组玻璃体腔再出血发生率显著低于对照组(P<0.05)。结论 Ranibizumab玻璃体腔注射辅助玻璃体切割术治疗PDR合并NVG,可有效降低术中出血次数,缩短手术时间,提高BCVA水平,降低术中及术后并发症发生率。

OBJECTIVE To investigate the clinical effect of intravitreal ranibizumab assisted pars plana virectomy in the treatment of proliferative diabetic retinopathy（PDR）combined neovascular glaucoma（NVG）.METHODS The clinical data of 53 cases（53 eyes）with PDR combined NVG during May 2013 to February 2016 were retrospectively analyzed.The observation group of 28 cases（28eyes）received intravitreal injection of Ranibizumab before pars plana virectomy,and the control group of 25 cases（25 eyes）only underwent vitrectomy.The operation and postoperative situation of the patients were observed and analyzed.RESULTS Compared with control group,the observation group was significantly shortened（P0.05）,and the time of neovessels bleeding,exchange frequency of surgical instruments and time of electric coagulation were significantly less than the control group（P0.05）.The incidence of intraoperative bleeding,iatrogenic retinal hole and fibrovascular residual of the observation group were lower than that of the control group.The mild bleeding incidence of the two group had significant difference.CRT of the observation group was significantly lower than the control group one month after the operation,and BCVA of the observation group was significantly higher than the control group（P0.05）.The postperative intraocular pressure was increased significantly after two weeks.The intraocular pressure in two grops were decreased after one month,among them the observation group was significantly lower than the control group（P0.05）,but there was no statistical significance in two groups compared with preoperative pressure（P0.05）.The incidence of vitreous rebleeding in observation group was significantly lower than the control group after the operation（P0.05）.CONCLUSION Intravitreal injection of Ranibizumab assisted vitrectomy for the treatment of PDR with NVG could effectively reduce the time of bleeding,shorten operation time,improve the level of BCVA,reduce the incidence rtes of intraoperative and postoperative complications.