玻璃体腔注射雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿的效果

Effect of intravitreal injection of Ranibizumab combined with retinal photocoagulation in the treatment of diabetic macular edema

目的探讨玻璃体腔注射雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿的效果。方法回顾性分析2017年1月~2018年1月在我院确诊的90例(91眼)糖尿病性黄斑水肿患者的临床资料,根据不同的治疗方式,将其分为治疗组(45例,46眼)和对照组(45例,45眼)。治疗组患者采用玻璃体腔注射雷珠单抗联合黄斑格栅样光凝或局灶光凝治疗,对照组患者采用雷珠单抗单独治疗。比较两组患者治疗后1、3个月的最佳矫正视力、治疗前后黄斑中心凹区域视网膜厚度、黄斑水肿渗漏及不良反应发生情况。结果治疗组患者治疗后3个月的最佳矫正视力优于对照组,差异有统计学意义(P<0.05);两组患者治疗后1个月的最佳矫正视力比较,差异无统计学意义(P>0.05)。两组患者治疗后1、3个月的黄斑中心凹区域视网膜厚度低于治疗前,差异有统计学意义(P<0.05);治疗组患者治疗后1、3个月的黄斑中心凹区域视网膜厚度低于对照组,差异有统计学意义(P<0.05)。对照组患者治疗后3个月的黄斑中心凹区域视网膜厚度高于本组治疗后1个月,差异有统计学意义(P<0.05)。治疗后3个月复查眼底血管造影,治疗组患者的渗漏眼占比低于对照组,差异有统计学意义(P<0.05)。治疗随访期间,两组患者均无眼部和全身不良反应。结论与玻璃体腔注射雷珠单抗单独治疗相比,雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿在改善视力、恢复视网膜功能方面效果更佳,且具有良好的安全性。

Objective To explore the effect of intravitreal injection of Ranibizumab combined with retinal photocoagulation in the treatment of diabetic macular edema.Methods A retrospective analysis was conducted on the clinical data of 90 patients(91 eyes)with diabetic macular edema diagnosed in our hospital from January 2017 to January 2018.According to different treatment methods,they were divided into the treatment group(45 cases,46 eyes)and the control group(45 cases,45 eyes).The patients in the treatment group were given intravitreal injection of Ranibizumab combined with macular grid photocoagulation or focal photocoagulation,and the patients in the control group were given Ranibizumab single treatment.The best corrected visual acuity at 1 month and 3 months after treatment,the retinal thickness at macula central fovea before and after treatment,the macular edema and leakage,and the occurrence of adverse reactions were compared.Results The best corrected visual acuity at 3 months after treatment in the treatment group was better than that in the control group,with statistically significant difference(P<0.05).There was no statistically significant difference in the best corrected visual acuity at 1 month after treatment between the two groups(P>0.05).The retinal thickness at macula central fovea in the two groups at 1 month and 3 months after treatment was lower than that before treatment,with statistically significant difference(P<0.05).The retinal thickness at macula central fovea in the treatment group at 1 month and 3 months after treatment was lower than that in the control group,with statistically significant difference(P<0.05).The retinal thickness at macula central fovea in the control group at 3 months after treatment was higher than that in the control group at 1 month after treatment,with statistically significant difference(P<0.05).The fundus fluorescein angiography was repeated at 3 months after treatment,and the proportion of leakage eyes in the treatment was lower than that in the control group,with statistically significant difference(P<0.05).During the treatment follow-up,there were no adverse reactions in eyes or whole body in the two groups.Conclusion In comparison with intravitreal injection of Ranibizumab single treatment,intravitreal injection of Ranibizumab combined with retinal photocoagulation has better effect in improving visual acuity and restoring retinal function in patients with diabetic macular edema,with better safety.