微创玻璃体切割术前不同间隔时间玻璃体腔内注射雷珠单抗辅助治疗增殖性糖尿病视网膜病变的疗效及安全性

Efficacy and safety of intravitreous injection of ranibizumab at different duration before minimally invasive vitrectomy as adjuvant therapy for proliferative diabetic retinopathy

目的探讨微创玻璃体切割术前不同间隔时间玻璃体腔内注射雷珠单抗辅助治疗增殖性糖尿病视网膜病变(PDR)的疗效及安全性。方法将72例PDR患者(72眼)随机分为A组、B组及C组,每组24例(24眼)。3组均接受25 G玻璃体切割术联合532 nm激光全视网膜光凝治疗,A组、B组分别于术前3 d、7 d行玻璃体腔内注射雷珠单抗,C组不行玻璃体腔内注射。比较3组术前和术后6个月最佳矫正视力(BCVA)、术后视力改善情况,以及手术时间、纤维增殖膜分级、医源性裂孔发生率、术中使用电凝数、硅油填充率。结果各组术后BCVA均较前改善(均P <0. 05),其中A组的改善情况优于C组(P <0. 05),但A组与B组比较,差异无统计学意义(P> 0. 05)。A组的手术时间短于C组,B组的医源性裂孔发生率低于C组,A组及B组的硅油填充率均低于C组(均P <0. 05),A组与B组间以上指标差异均无统计学意义(均P> 0. 05)。结论对于PDR患者,玻璃体切割术前玻璃体腔内注射雷珠单抗可以提高玻璃体切割术的疗效及安全性。与术前7 d玻璃体腔内注射比较,术前3 d注射获得的治疗效果相当,但可能在更大程度上预防不良反应的发生。

Objective To explore the efficacy and safety of intravitreous injection of ranibizumab at different duration before minimally invasive vitrectomy as adjuvant therapy for proliferative diabetic retinopathy(PDR).Methods Seventy-two patients(72 eyes)with PDR were randomly divided into group A,group B and group C,with 24 cases(24 eyes)in each group.The three groups received 25 G vitrectomy and 532nm laser panretinal photocoagulation,group A and group B underwent intravitreous injection of ranibizumab at 3 and 7 days before vitrectomy respectively,and intravitreous injection was not conducted in group C.The preoperative and 6-month postoperative best corrected visual acuity(BCVA)and postoperative visual acuity improvement were compared among the three groups,and the operation duration,classification of fibrovascular proliferation,incidence rate of iatrogenic retinal hole,frequency of endodiathermy used during operation,and rate of silicone oil injection were also compared among the three groups.Results The postoperative BCVA was improved in each group compared to the preoperative BCVA(all P<0.05),and the improvement of group A was superior to that of group C(P<0.05),but no statistically significant difference was found between group A and group B(P>0.05).Compared to group C,the operation duration was shorter in group A,the incidence rate of iatrogenic retinal hole was lower in group B,and the rates of silicone oil injection were lower in group A and group B(all P<0.05),but no statistically significant difference was found in the indices above between group A and group B(all P>0.05).Conclusion For the patients with PDR,intravitreous injection of ranibizumab before vitrectomy can improve the efficacy and safety of vitrectomy.Compared to 7-day preoperative intravitreous injection,three-day preoperative injection can achieve a similar efficacy,but probably prevent against adverse reactions to a greater extent.