玻璃体切除联合抗VEGF药物治疗增殖性糖尿病视网膜病变

Minimally invasive vitrectomy combined with anti-VEGF drugs for the treatment of proliferative diabetic retinopathy

目的观察微创玻璃体切除联合抗-VEGF药物治疗增殖性糖尿病视网膜病变的临床效果。方法62例(64眼)增殖性糖尿病视网膜病变的患者,随机分为2组,A组32例(34眼),B组30例(30眼);两组患者均行25G+微创玻璃体切割术,A组患者术前5~7 d玻璃体腔注射康柏西普;B组患者术毕玻璃体腔注射康柏西普。观察并比较两组患者手术时间、术中出血情况、玻璃体填充物应用、最佳矫正视力、黄斑中心凹厚度、玻璃体再出血及并发症发生情况等。结果A组平均手术时间较B组短,A组术中出血发生率低于B组,两组术后2周最佳矫正视力及同一组术前、术后黄斑中心凹厚度的比较,差异均有统计学意义(P<0.05);两组玻璃体腔填充物应用及两组术后1个月黄斑中心凹厚度比较,差异无统计学意义(P>0.05);B组玻璃体再出血发生率明显降低,差异有统计学意义(P<0.05)。结论PPV术前玻璃体腔注射抗VEGF药物能明显缩短手术时间,减少术中出血,降低手术难度,易化手术操作。PPV术毕玻璃体腔注射抗VEGF药物可降低玻璃体再出血的发生率,改善术后黄斑水肿的严重程度,视力可快速恢复。PDR的患者围手术期应用抗VEGF药物疗效确切,改善视力预后,临床上可推广使用。

Objective To observe the clinical effect of minimally invasive vitrectomy combined with anti-VEGF drugs in the treatment of proliferative diabetic retinopathy.Methods Sixty-two cases(64 eyes)of proliferative diabetic retinopathy were randomly divided into 2 groups,32 patients in Group A(34 eyes)and 30 patients in Group B(30 eyes).All the cases received 25G+minimally invasive vitrectomy.In Group A,intravitreal injection of conbercept was performed 5 to 7 days before operation.Patients in Group B received intravitreal injection of conbercept at the end of operation.The operation time,intraoperative bleeding,rate of using intraocular tamponade,best corrected visual acuity(BCVA),central retinal thickness(CRT),and incidence of postoperative complications were compared.Results The operation time of Group A was shorter than Group B.The incidence of intraoperative bleeding in Group A was lower than Group B.The BCVA and central retinal thickness of the both groups 2 weeks after the operation were significantly improved(P<0.05).The rate of using intraocular tamponade and the central retinal thickness 1 month after the operation between the two groups were not significant different(P>0.05).The incidence of vitreous rebleeding was significantly lower in Group B(P<0.05).Conclusion Intravitreal injection of anti-VEGF drugs before PPV can significantly shorten the operation time and reduce intraoperative bleeding.Intravitreal injection of anti-VEGF drugs when PPV finished can greatly reduce the incidence of vitreous rebleeding,improve postoperative macular edema and quickly restore vision.Perioperative application of anti-VEGF drugs in patients with PDR is effective.