玻璃体切除术及抗VEGF药物治疗糖尿病性视网膜病变黄斑水肿

Vitrectomy combined with intravitreal anti-VEGF injection for proliferative diabetic retinopathy with macular edema

目的比较玻璃体切除术前和术中联合玻璃体腔注射抗VEGF药物治疗增生性糖尿病性视网膜病变(PDR)黄斑水肿的临床效果。方法回顾性分析2018年10月至2019年6月PDR黄斑水肿60例(60眼)的临床资料。所有患者分为玻璃体切除术前玻璃体内注射抗VEGF药物组(术前组)和玻璃体切除术中玻璃体腔注射抗VEGF药物组(术中组),每组30例。比较两组的手术效果。结果术前组的手术时间短于术中组(t=6.965,P=0.023),出血量少于术中组(t=4.541,P=0.016),住院时间短于术中组(t=3.365,P=0.032)。患者的视力、眼压、黄斑中心区厚度及血清VEGF水平术前两组之间的差异均无统计学意义(P>0.05)。术前组术后的视力、眼压、黄斑中心区厚度及血清VEGF水平均优于术中组(P<0.05)。术前组总有效率为96.7%(29/30),高于术中组的83.3%(χ^2=11.140,P=0.020)。术前组并发症发生率为6.7%低于术中组的40.0%(χ^2=16.010,P=0.033)。结论玻璃体切除术前玻璃体内注射抗VEGF药物治疗PDR黄斑水肿的效果优于术中注射者。

Objective To compare the clinical efficacy of intravitreal anti-VEGF injection between before and during vitrectomy for proliferative diabetic retinopathy with macular edema.Methods The clinical data of 60 eyes of 60 patients with proliferative diabetic retinopathy and macular edema from Oct.2018 to Jun.2019 were retrospectively analyzed.All cases were divided into two groups.Group A,30 cases received intravitreal injection of anti-VEGF before vitrectomy and group B,30 cases received intravitreal injection of anti-VEGF during vitrectomy.The clinical efficacy between the two groups were compared.Results The operation time of group A was significantly shorter than that of group B(t=6.965,P=0.023).The intraoperative hemorrhages quantities in group A was significantly less than that of group B(t=4.541,P=0.016).And the hospitalization time of group A was significantly shorter than that of group B(t=3.365,P=0.032).The difference of visual acuity(logMAR),intraocular pressure,central macular thickness(CRT)and serum VEGF level between the two groups before treatment were not statistically significant(P<0.05).The visual acuity,IOP,CRT and VEGF level after treatment were significantly better than those before treatment(P<0.05).The visual acuity,intraocular pressure,CRT and serum VEGF level in group A after treatment were significantly better than those in group B(P<0.05).The total effective rate was 96.7%(29/30)in group A which was better than 83.3%(25/30)in the group B.The difference of total effective rate was statistically significant between the two groups(χ^2=11.140,P=0.020).The incidence of complications in group A was 6.7%,which was significantly lower than 40.0%in group B(χ^2=16.010,P=0.033).Conclusion Intravitreal injection of anti-VEGF before vitrectomy for proliferative diabetic retinopathy with macular edema is more effective than during vitrectomy.