内界膜剥除联合或不联合玻璃体腔注射康柏西普治疗顽固性糖尿病黄斑水肿的疗效对比观察

Effects of internal limiting membrane peeling with or without intravitreal Conbercept in the treatment of refractory diabetic macular edema

目的对比观察玻璃体腔注射康柏西普联合内界膜剥除与单纯内界膜剥除治疗顽固性糖尿病黄斑水肿(DME)的疗效。方法回顾性病例对照研究。将临床确诊为继发于糖尿病视网膜病变(DR)的顽固性黄斑水肿并行内界膜剥除术治疗的患者36例(36只眼)纳入研究,将患者分为玻璃体腔注射康柏西普联合内界膜剥除组(联合组)16例(16只眼)和单纯内界膜剥除组(对照组)20例(20只眼)。比较两组患者手术前及手术后1、3、6个月时的最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)及并发症发生情况。结果联合组视网膜厚度降低明显,视力提高快,手术后1、3、6个月平均CMT分别为(343.13±74.50)μm、(300.50±60.82)μm、(267.88±56.30)μm,手术后平均CMT和log MAR BCVA与手术前比较,差异均有统计学意义(P<0.05)。对照组手术后1月视力提高不明显,与手术前比较差异无统计学意义(P=0.097)。手术后1、3、6个月视网膜厚度逐步降低,分别为(406.10±94.84)μm、(327.65±88.91)μm、(275.30±61.09)μm。组间比较,联合组手术后1个月平均log MAR BCVA和CMT均优于对照组,差异有统计学意义(P<0.05)。结论玻璃体腔注射康柏西普联合内界膜剥除能更有效促进顽固性糖尿病黄斑水肿的吸收,提高患者视力。

Objective To compare the effect of internal limiting membrane peeling with or without Intravitreal Conbercept in the treatment refractory diabetic macular edema（ DME）. Methods Thirty-six patients（ 36 eyes） with refractory macular edema secondary to diabetic retinopathy（ DR） were enrolled. This cases were divided into a intravitreal Conbercept combined with internal limiting membrane peeling group of 16 eyes（ combined group） and simple limiting membrane peeling group of 20 eyes（ control group）. Results Outcomes were significantly better in combined group as demonstrated by reduced retinal thickness and improved visual acuity. The CMT were 343. 13 ± 74. 50μm、300. 50 ± 60. 82μm、267. 88 ± 56. 30 μm at 1,3 and 6 months. in combined group,the CMT and log MAR BCVA were significantly better than preoperative situation（ P〈0. 05）. In control group,the improvement in BCVA was not not significantly at 1 month（ P = 0. 097）. The CMT decreased gradually at 1,3 and 6 months,they were 406. 10 ± 94. 84 μm、327. 65 ± 88. 91 μm、275. 30 ± 61. 09 μm. The postoperative mean log MAR BCVA and CMT in combined group at 1 month were both better than that in control group（ P〈0.05）. Conclusion Intravitreal Conbercept combined with internal limiting membrane peeling can facilitate the resolve of refractory diabetic macular edema.