康柏西普和雷珠单抗联合玻璃体切除术治疗PDR的疗效比较

Efficacy comparison of Conbercept and Ranibizumab as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy

目的:比较两种抗VEGF药物康柏西普和雷珠单抗在增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者玻璃体切除术(pars plana vitrectomy,PPV)术中和术后的作用。方法:将2016-06/12于我科确诊为PDR伴有玻璃体出血(vitreous hemorrhage,VH)和/或牵引性视网膜脱离(tractional retinal detachment,TRD)的62例64眼41~59岁患者纳入研究,于PPV术前3d玻璃体腔注射抗VEGF药物0.50mg(0.05mL),无明显并发症后行标准23G微创巩膜三通道玻璃体切除术,记录并分析手术时间、术中出血、医源性视网膜裂孔、眼内电凝使用、是否硅油填充等,对术前及术后1mo视力及黄斑厚度进行对比,观察术后并发症情况。结果:两种抗VEGF药物预处理对手术时间、术中出血、医源性视网膜裂孔、眼内电凝使用、是否硅油填充及术后玻璃体二次出血发生率均无明显统计学差异,且二者均可提高PPV术后视力,减低术后黄斑厚度。结论:康柏西普和雷珠单抗二者效果相似,预处理联合PPV可提高患者术后视力,改善黄斑水肿,可根据患者实际情况灵活选择。

AIM： To analyze the effects of two kinds of anti- vascular endothelial growth factor （ VEGF ） drugs, conbercept and ranibizumab, on proliferative diabetic retinopathy （PDR） patients as pretreatment for pars plana vitrectomy （PPV）. METHODS： From June 2016 to December 2016, 62 patients （64 eyes） aged 41-59 years old diagnosed with PDR with nonclearing vitreous hemorrhage （VH） and/or tractional retinal detachment （TRD） requiring PPV were enrolled in our study. Patients were treated with intravitreal injection of anti-VEGF drugs 0.50rag （0.05mL） 3d before PPV. Then the standard 23G minimally invasive sclera three- channel vitrectomy was performed where there were no significant complications after the injection of anti-VEGF drugs. The operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy and silicone oil, and postoperative complications were recorded and analyzed. We compared and analyzed the visual acuity and macular thickness before and lmo after the surgery with the preoperative data. RESULTS： Both conbercept and ranibizumab could improve the postoperative visual acuity and reduce the postoperative macular thickness of PPV. There was no significant difference between the impacts of two kinds of anti- VEGF drug pre- treatment on operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy, silicone oil filling and postoperative vitreous secondary hemorrhage. CONCLUSION. The effects of conbercept and ranibizumab pre-treatment were similar. PPV combined with anti - VEGF pre - treatment could improve postoperative visual acuity and macular edema. The choice of conbercept or ranibizumab should be made flexibly according to the actual situation of patients.