术前玻璃体腔注射康柏西普对严重增生型糖尿病视网膜病变手术的影响

Intravitreal conbercept as a pretreatment of vitrectomy for patients with severe proliferative diabetic retinopathy

目的评估术前玻璃体腔注射康柏西普对严重增生型糖尿病视网膜病变(PDR)玻璃体切除手术操作的作用、安全性和有效性。方法前瞻性随机对照研究。将诊断为PDR合并玻璃体积血或牵拉性视网膜脱离的患者36例(36眼)随机平均分为2组。注药组:术前1周行颞下方距角膜缘4 mm处经睫状体平坦部穿刺玻璃体腔注射康柏西普,所有注射均为无菌操作;对照组:术前未行任何玻璃体腔注药。所有患者行玻璃体切除术。比较2组的平均手术时间、术中出血量、电凝止血率、医源性视网膜裂孔、手术填充物类型等情况。结果 2组患者术前的基线特征比较差异无统计学意义。注药组:平均手术时间为(43±8)min;2例(11.1%)发生术中出血,1例(5.5%)术中必须采用眼内电凝止血;全部手术过程中无一例发生医源性视网膜裂孔或行视网膜松解术;硅油填充2例(11.1%)。对照组:平均手术时间为(53±10)min;14例(77.8%)发生术中出血,其中5例出血严重,8例(44.4%)术中必须采用眼内电凝止血;术中发生医源性视网膜裂孔3例(16.6%);行视网膜松解术1例(5.5%);硅油填充12例(66.6%)。结论术前玻璃体腔注射康柏西普能减少PDR玻璃体切除术中的出血率,显著缩短手术时间,提高手术操作的安全性。

Objective To evaluate the role, safety and effectiveness of intravitreal conbercept injection as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy （PDR）. Methods A randomized controlled trial was performed. Thirty-six eyes of 36 patients were affected by vitreous hemorrhage and tractional retinal detachment, which occurred as a consequence of active PDR. All patients were randomly assigned to two groups. The patients in one group received an intravitreal injection of conbercept in the inferior temporal sector 4 mm from the sclerocorneal limbus with a sterile technique 1 week before vitrectomy. The patients in the other group never received intravitreal injection. The main measures were mean surgical time, intraoperative bleeding, incidence of iatrogenic retinal breaks, relaxing retinotomy, and types of temponade. Results In the group treated with conbercept, the mean surgical time was 43 ± 8 min, intraoperative bleeding occurred in 2 patients （11.1% ）. The use of endodiathermy was necessary in leye （5.5%）. No patients experienced iatrogenic break or relaxing retinotomy during the surgery. Endotemponade with silicone was performed in 2 patients （ 11. 1% ）. In the group without conbercept, the mean surgical time was 53 -＋ 10 rain, intraoperative bleeding occurred in 14 eyes（77.8% ）, and in 5 of these cases, bleeding was significant. The use of endodiathermy was necessary in 8 eyes （44.4%）. In 3 patients （ 16.6% ）, iatrogenic retinal breaks occurred, and in 1 patient （5.5%） , relaxing retinotomy was performed. Endotemponade with silicone was performed in 12 patients（66.6% ）. Conclusions Preoperative intravitreal injection of conbercept could reduce the chances of intraoperative bleeding, which are beneficial in the management of PDR.