同轴微切口白内障超声乳化联合雷珠单抗玻璃体腔注射治疗白内障并糖尿病性黄斑水肿的临床观察

The combination of micro incision phacoemulsification and intravitreal ranibizumab in patients with cataract and diabetic macular edema

目的观察同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗治疗糖尿病性黄斑水肿的临床疗效。方法选择2014年7月—2016年11月在我院就诊的68例(72只眼)患有老年性白内障合并糖尿病性黄斑水肿患者,分为2组,治疗组(32例,34只眼)行同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗;对照组(36例,38只眼)单纯行白内障超声乳化摘除;观察指标包括术前、术后最佳矫正视力、眼压及黄斑中心凹视网膜厚度,观察时间为术前、术后1周、1月、3月、6月、12月。结果术后两组最佳矫正视力与术前相比差异有统计学意义(P<0.01);术前及术后1周2组最佳矫正视力无差异,术后1月、3月、6月、12月治疗组最佳矫正视力均优于对照组;术前2组患者黄斑中心凹视网膜厚度相比无明显差异,术后各个时间点治疗组黄斑中心凹视网膜厚度均低于对照组,二者相比差异有差异性(P均<0.001);两组患者术前及术后眼压无差异(P<0.05)。结论对老年性白内障合并糖尿病性黄斑水肿患者,术中联合玻璃体腔注射雷珠单抗,可减轻术后黄斑水肿,改善患者术后中、远期视力。

Objective To assess the safety and efficiency of combination of micro incision phacoemulsification（PHACO） surgery and intravitreal ranibizumab injection in patients with cataract and diabetic macular edema. Methods The selected 68 patients（ 72 eyes） with age-related cataract and diabetic macular edema were randomly divided into two groups： the PHACO and intravitreal Ranibizumab injection（ treatment group,32 cases,34 eyes）,and only PHACO（ control group,36 cases,38 eyes） in our hospital from July 2014 to November 2016. Preoperative and postoperative best corrected visual acuity（ BCVA）,central macular thickness（ CMT）,and intraocular pressure（ IOP） were recorded. The time points included preoperative day,1 week,1 month,3 months,6 months and 12 months after surgery. Results Postoperative BCVA during the follow-up period was higher than the initial BCVA in both groups（ P 〈 0. 01）. There was no statistically significant difference between both groups in BCVA at pre-operation and 1 week after surgery. In the treatment group,the postoperative BCVA was significantly higher than the control group at 1 month,3 months,6 months and 12 months after operation. The mean CMT in the treatment group was lower than the control group in all the follow-up time. There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period（ P 〉 0. 05）. Conclusion Additional intravitreal ranibizumab injection after PHACO surgery reduced macular edema and preserved this improvement in the mid-and-long term of BCVA.