雷珠单抗联合全视网膜激光光凝治疗重度非增生型糖尿病视网膜病变的疗效观察

Ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy

目的探讨雷珠单抗玻璃体内注射联合全视网膜激光光凝治疗重度非增生型糖尿病视网膜病变的临床疗效。方法将本院2014年7月至2016年6月收治的重度非增生型糖尿病视网膜病变患者64例(90眼),随机分为两组:对照组32例(44眼)单纯采用全视网膜激光光凝(panretinal photocoagulation,PRP)治疗,观察组32例(46眼)采用玻璃体内注射雷珠单抗联合PRP治疗,观察两组治疗前,治疗后1个月、3个月、6个月的最佳矫正视力(best corrected visual acuity,BCVA)、眼底、眼底荧光血管造影(fundus fluorescein angiography,FFA)、黄斑区视网膜神经上皮层厚度和黄斑区6 mm直径神经上皮总体容积,记录并计算治疗中的激光能量、光斑数和能量密度,对上述数据进行比较。结果对照组和观察组患者治疗后1个月、3个月、6个月时BCVA均优于治疗前(均为P<0.05),并且观察组患者治疗后1个月、3个月、6个月时BCVA均优于对照组(均为P<0.05);对照组治疗后6个月时BCVA与治疗后3个月比较,差异无统计学意义(P>0.05),其他时间点比较差异均有统计学意义(均为P<0.05);观察组治疗后各时间点比较差异均有统计学意义(均为P<0.05)。黄斑区视网膜神经上皮层平均厚度和黄斑区6 mm直径神经上皮总体容积的对比中,对照组和观察组治疗前后比较、治疗后两组中不同时间点之间比较差异均有统计学意义(均为P<0.05)。并且观察组患者治疗后1个月、3个月、6个月时黄斑区视网膜神经上皮层厚度、黄斑区6 mm直径神经上皮总体容积均优于对照组(均为P<0.05)。观察组在激光能量、光斑数和能量密度均显著低于对照组(均为P<0.05)。结论玻璃体内注射雷珠单抗联合PRP治疗重度非增生型糖尿病视网膜病变,利用较少的激光能量,可在较短时间内加快视网膜新生血管的消退、减轻黄斑水肿并改善患者的视功能,其疗效优于单纯应用PRP治疗,值得临床推广。

Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy.Methods Sixty-four cases （90 eyes） with severe non-proliferative diabetic retinopathy from July 2014 to June 2016 in our hospital were randomly divided into two groups according to the digital table.The observation group （32 cases,46 eyes） underwent intravitreal injection of reizumab combined with panretinal photocoagulation,and the control group（32 cases,44 eyes） were treated with only panretinal photocoagulation.The visual acuity,fundus,fundus fluorescein angiography and macular thickness postoperative 1 month,3 months,6 months were observed and detected.The mean thickness of the retinal neuroepithelium in the macular region and total volume of the 6 mm diameter neuroepithelium in the macular area were compared and statistically analyzed.The laser energy,number of spots and energy density were calculated and recorded.Results BCVA at postoperative 1 month,3 months,6 months in the observation and the control group were better than that before treatment（all P〈0.05）,and the observation group was better than the control group （all P〈0.05）.In the control group,BCVA had no statistically significant difference between 3 months and 6 months （P〉0.05）,and the differences were statistically significant among other time points （all P〈0.05）.In the observation group,the differences were statistically significant among all time points after treatment （all P〈0.05）.In the comparison of mean thickness of the retinal neuroepithelium in the macular region and total volume of the 6 mm diameter neuroepithelium in the macular area in the control group and the observation group before and after treatment,there were statistically significant differences at different time points between the two groups （all P〈0.05）.Moreover,the average thickness of the retinal neuroepithelium and total volume of 6 mm diameter neuroepithelium in the macular region at postoperative 1 month,3 months,6 months were better than those in the control group （all P〈0.05）.The laser energy,spot number and energy density of the observation group were significantly lower than those of the control group （all P〈0.05）.Conclusion Intravitreal injection of ranibizumab combined with panretinal photocoagulation for severe non-proliferative diabetic retinopathy can accelerate retinal neovascularization in a short period of time,reduce macular edema and improve the visual function of patients with less laser energy,the curative effect is better than application of retinal laser photocoagulation alone,is worthy of clinical promotion.