术前注射曲安奈德对PDR患者25 G微创VRS术效果及预后的影响

Impacts of preoperative injection of TA on effects of 25G minimally invasive VRS and prognosis in patients with PD

目的探讨术前注射曲安奈德(TA)对增生型糖尿病性视网膜病变(PDR)25 G微创玻璃体视网膜手术(VRS)效果及患者预后的影响。方法将笔者科室收治的需行VRS治疗的PDR患者108例(共108只患眼)随机分为两组,将术前1 w行玻璃体腔注射TA的54例归为VRS+TA组,另外54例直接行VRS治疗的归为VRS组,比较两组手术情况,术前和术后3个月裸眼视力、最佳矫正视力,术前、术后1 w、术后1个月和术后3个月眼压和并发症情况。结果 VRS+TA组手术时间、电凝率、医源性裂孔率和术中出血率显著短于或低于VRS组(P<0.05),而两组眼内硅油、C3F8气体、灌洗液填充物使用率差异不显著(P>0.05);两组术后3个月裸眼视力和最佳矫正视力均得到显著提高(P<0.05),两组间无显著差异(P>0.05);VRS+TA组术后1和3个月眼压较术前显著升高(P<0.05);术后3个月,VRS+TA组前房渗出率显著低于VRS组(P<0.05),但两组并发症总发生率比较无显著差异(P>0.05)。结论 PDR患者行VRS治疗前1 w行玻璃体腔注射TA,可降低手术难度,缩短手术时间,并减少并发症,利于患者术后视力改善。

Objective To explore the impacts of preoperative injection of triamcinolone acetonide（TA） on the effects of 25 G minimally invasive vitreous retinal surgery（VRS） and prognosis in the patients with proliferative diabetic retinopathy（PDR）.Methods A total of 108 patients（a total of 108 affected eyes） with PDR to receive VRS in our department were randomly divided into a VRS＋TA group and a VRS group（n=54,respectively）.The VRS＋TA group received intravitreal injection TA one week before the surgery and the VRS group directly received VRS.The operation conditions,the uncorrected visual acuity（UCVA） and the best corrected visual acuity（BCVA） three months before and after the surgery,the intraocular pressure（IOP） and complications one week before,one week after,one month after and three months after the surgery between the two groups were compared.Results The operation time,electric coagulation rate,iatrogenic fracture rate and intraoperative bleeding rate in the VRS ＋TA group were significantly shorter or lower than those in the VRS group（P〈0.05）,while the differences in the intraocular silicone oil,C3 F8 and utilization rate of irrigating solution and filler between the two groups were not significant（P〈0.05）; the UCVA and the BCVA three months after the surgery were remarkably improved（P〈0.05） and there was no significant difference between the two groups（P〈0.05）; the IOPs in the VRS ＋TA group one month and three months after the surgery were significantly higher than that before the surgery（P〈0.05）; three months after the surgery,the anterior chamber effusion rate in the VRS＋TA group was much lower than that in the VRS group（P〈0.05）,but the overall incidence of complications between the two groups showed no significant difference（P〈0.05）.Conclusion Intravitreal injection TA one week before VRS in patients with PDR can reduce the difficulty of surgery,shorten the operation time and reduce complications,and is beneficial to the post-operative visual improvement.