玻璃体腔内注射康柏西普治疗糖网玻切术后玻璃体再出血的临床观察

Intravitreal conbercept injection for recurrent vitreous haemorrhage after diabetic vitrectomy

目的 评价玻璃体腔内注射康柏西普在治疗糖尿病视网膜病变玻璃体切割术后迟发性玻璃体再出血（postvitrectomy diabetic vitreous hemorrhage,PVDVH）的疗效.方法 连续收集迟发性PVDVH的患者36例36只眼,随机分为治疗组（17只眼）和对照组（19只眼）,治疗组给予康柏西普0.05 ml玻璃体腔内注射,如4周后玻璃体积血无明显吸收则重复注射,直到积血清除.对照组给予和血明目片、卵磷脂络合碘口服.随诊5～13个月,平均（8.5±2.5）个月.结果 治疗组的玻璃体积血清除时间为2～8周,平均（5.3±2.3）周,平均注药（2.2±0.8）次;4只眼治疗过程中再次发生出血,但经过注射治疗后积血再次吸收,无一眼需再次行PPV.对照组中8只眼积血在3～10周,平均（6.7±2.5）周时吸收,11只眼治疗过程中发生再次出血,其中1眼在按对照组治疗方式继续治疗后积血最终吸收,余10只眼积血长时间未见吸收,其中有4只眼发生新生血管青光眼,4只眼出现牵拉性视网膜脱离,最终以上10眼需再次行玻璃体切割手术.治疗组视力明显好于对照组.结论 玻璃体腔内注射康柏西普能缩短PVDVH的吸收时间,降低并发症及再次玻璃体切割手术的几率.

Objective To assess the effects of intravitreal conbercept in treating delayed post-vitrectomy （4 weeks after surgery） diabetic vitreous hemorrhage （PVDVH）.Methods Of 36 consecutive patients （36 eyes） with delayed PVDVH were assigned to tow groups,the study group （17 eyes） and the control group （19 eyes）.The study group was treated with intravitreal conbercept,and repeated injection was given after 4 weeks in cases with no obvious blood absorption,until the blood was absorbed completely.The control group was given Chinese traditional medicine and iodized lecithin.The average follow-up duration was 8.5±2.5 months （ranged,5～13 months）.Results VCT of the study group was 2-8 weeks,mean 5.3±2.3 weeks,with average injection 2.2±0.8 times.Four eyes had developed recurrent vitreous hemorrhage （VH）,but all of the eyes had a clear vitreous at the end of study period,and no vitrectomy surgery was needed.In the control group,eight eyes had spontaneous reabsorption in 3-9 weeks,mean 6.7±2.5 weeks,11 eyes developed recurrent VH,the blood of one eye finally had been absorbed,10 eyes had persistent VH,4 eyes of them had iris neouvasculrization,and 4 eyes of them had retinal detachment,and finally these 10 eyes underwent revitrectomy surgeries.The vision of the study group was better than that in the control group.Conclusions Intravitreal conbercept treatment can accelerate the clear-up of the VH,reduce the complication and the need of revitrectomy for PVDVH.