康柏西普术前、术中辅助玻璃体切除术治疗增生型糖尿病视网膜病变的临床效果观察

Clinical effect of vitrectomy combined with preoperative and intraoperative intravitreal Conbercept for proliferative diabetic retinopathy

目的观察比较单纯玻璃体切除术与术前、术中或术前术中联合应用康柏西普辅助玻璃体切除术治疗增生型糖尿病视网膜病变(PDR)的临床效果。方法回顾性分析我院近3年23G玻璃体切除术治疗PDR病例,按不同治疗方法共纳入187例(187只眼,均为单眼),A组为术前注射康柏西普辅助微创手术治疗(45例)、B组为术前术中联合注射康柏西普辅助微创手术治疗(48例)、C组为术中注射康柏西普辅助微创手术治疗(44例)、D组为单纯微创手术治疗(50例)。观察比较各组手术时间、术中不良事件、术后并发症及术后6个月最佳矫正视力(BCVA)与黄斑中心凹视网膜厚度(CMT)。结果A、B、C组较D组可显著缩短手术时间、降低术中不良事件与术后并发症发生率(P<0.05),并可以显著改善术后BCVA及CMT(P<0.05),术前术中联合应用效果更佳。同时,术中应用康柏西普可能对控制晚期出血更为重要,而术前应用康柏西普可能对于改善患者术后CMT更为重要。结论术前与术中注射康柏西普辅助微创玻璃体切除术治疗PDR效果良好、安全性好,值得临床推广。

Objective To compare the clinical effect of simple vitrectomy,vitrectomy combined with preoperative, intraoperative or both preoperative and intraoperative intravitreal Conbercept injection for treating proliferative diabetic retinopathy (PDR).Methods A retrospective analysis was performed based on the PDR cases treated by 23G vitrectomy in our hospital in the last 3 years.A total of 187 PDR patients was included and divided into four groups according to different vitrectomy treatments,including group A: vitrectomy combined with preoperative intravitreal Conbercept injection (45 cases);group B:vitrectomy combined with preoperative and intraoperative intravitreal Conbercept injection (48 cases);group C: vitrectomy combined with intraoperative intravitreal Conbercept injection (44 cases);group D:simple vitrectomy (50 cases).The surgery durations,intraoperative adverse events,postoperative complications, as well as the best corrected visual acuity (BCVA) and central macular thickness (CMT) measured 6 months after the surgery were compared among different groups.Results The surgery durations and the incidences of both intraoperative adverse events and postoperative complications were significantly reduced in group A,B and C as compared with those in group D ( P <0.05).In addition,the postoperative BCVA and CMT were significantly improved ( P <0.05) in group A,B and C.Vitrectomy combined with preoperative and intraoperative intravitreal Conbercept injection showed better results.We also found that intraoperative intravitreal Conbercept injection might be more important for controlling the late hemorrhage,while preoperative intravitreal Conbercept injection might be more important for improving the postoperative CMT.Conclusions Vitrectomy combined with preoperative and intraoperative intravitreal Conbercept injection shows effective and reliable performance in treating PDR,which is worthwhile for clinical application.