术前玻璃体腔注射雷珠单抗对PDR患者VRS围手术期指标的影响

Influence of preoperative intravitreal injection of Ranibizumab on perioperative VRS parameters in patients with PDR

目的:探讨手术前玻璃体腔注射雷珠单抗对增生型糖尿病视网膜病变(prolifertive dibetic retinopthy,PDR)患者25G微创玻璃体视网膜手术(vitreoretinal surgery,VRS)围手术期指标的影响。方法:采用回顾性研究。选取2013-02/2015-12我院接受VRS治疗的PDR患者74例82眼,根据术前玻璃体腔是否注射雷珠单抗分为VRS+术前玻璃体腔注射雷珠单抗组和仅行VRS组。记录VRS手术时间、填充物情况、医源性视网膜裂孔等情况。结果:VRS+术前玻璃体腔注射雷珠单抗组手术时间和电凝次数均显著低于VRS组,两组手术时间和电凝次数比较差异均有统计学意义(P<0.05);VRS+术前玻璃体腔注射雷珠单抗组医源性视网膜裂孔发生和使用硅油为填充物的例数均低于VRS组,两组比较差异均有统计学意义(P<0.05);而使用C_3F_8和灌注液作为填充物的例数比较差异均无统计学意义(P>0.05);VRS+术前玻璃体腔注射雷珠单抗组术后3mo内有4眼出现玻璃体再积血,VRS组术后3mo内有13眼出现玻璃体再积血,两组患者术后3mo内出现玻璃体再积血发生率比较差异有统计学意义(χ~2=4.966,P<0.05)。结论:PDR患者25G微创VRS术前玻璃体腔注射雷珠单抗治疗能够减少术中眼部出血、视网膜损伤,缩短手术时间,提高手术成功率并降低术后眼部再出血、再粘连等并发症的发生率。

AIM： To discuss the effects of preoperative vitreous cavity injection of ranibizumab on 25G minimally invasive vitreoretinal surgery （VRS） in patients with proliferative diabetic retinopathy（PDR）.METHODS： From February 2013 to December 2015,74 patients with PDR received VRS （82 eyes） were retrospectively analyzed.Patients were divided into VRS ＋ IVR group and VRS group according to preoperative VRS treatment.VRS＋IVR group： preoperative injection of ranibizumab （10mg / mL） at 3-5d before operation;VRS group： VRS only.We recorded VRS operation time,filling situation,iatrogenic retinal hole and so on.RESULTS： The operation time and coagulation times of VRS＋IVR group were significantly lower than VRS group.The two groups in operation time and coagulation times were statistically significant （all P〈0.05）.In the VRS＋IVR group,the number of cases of iatrogenic retinal hole and the use of silicone oil were lower than those of VRS group,the difference between the two groups was statistically significant （P〈0.05）.While the use number of C3F8 and perfusion fluid were not statistically significant （P〉0.05）.In VRS-IVR group within 3mo after operation,4 eyes appeared to vitreous body hematocele,VRS group was 13 eyes,the difference was statistically significant （χ^2=4.966,P〈0.05）.CONCLUSION： PDR patients with 25G minimally invasive VRS with preoperative therapy can reduce postoperative ocular bleeding,rate of retinal injury and silicone oil filling,shorten the operation time,the incidence rate and improve the success rate of surgery and reduce eye bleeding,postoperative complications such as adhesion.