抗VEGF药物在PDR患者玻璃体切割手术前应用的临床研究

Clinical observation of intravitreal anti-VEGF drugs injection before vitrectomy in patients with PDR

目的探讨在增殖性糖尿病性视网膜病变患者进行玻璃体手术之前进行抗VEGF药物治疗对其手术难度、术中术后并发症及疗效情况等的影响。方法选取安徽省立医院2018-08至2020-05诊断为增殖性糖尿病性视网膜病变(PDR)并拟予以23G玻璃体切割术进行治疗的患者43人50例患眼。将50例患眼分为眼内注药组与对照组,其中眼内注药组17人20例患眼,对照组26人30例患眼。眼内注药组于23G玻璃体切割手术前3~7天行玻璃体腔内注入抗VEGF药物治疗,对照组收住入院后不经注药直接行23G玻璃体切割手术。观察对照并统计分析两组手术时间、术中及术后并发症以及随访半年的视力变化情况。结果眼内注药组术中出血及电凝使用的患眼明显少于对照组,两组比较差异有统计学意义(x^(2)=3.955,P<0.05)。眼内注药组术后再出血及手术的患眼也明显少于对照组,两组比较差异有统计学意义(x^(2)=4.084,P<0.05)。眼内注药组术后高眼压的发生率明显少于对照组,两组比较差异有统计学意义(x^(2)=4.084,P<0.05)。但眼内注药组与对照组手术时间比较差异无统计学差异(t=0.248,P>0.05)。而术中眼内填充物的使用眼内注药组眼数少于对照组,但两组比较差异没有统计学意义(x^(2)=0.013,P>0.05)。眼内注药组术后半年内随访的视力好转率均高于对照组,但两组比较差异没有统计学意义(P>0.05)。结论经过上述治疗后,PDR患者进行23G玻璃体切割手术前行玻璃体腔内抗VEGF药物注射可以减少术中出血的发生,降低术中电凝的使用率,并且可以减少术后并发症的发生,包括术后再出血、术后视网膜脱离,术后高眼压等,继而减少术后再次手术的几率。但术中眼内填充物的使用、手术时间长度及术后视力好转与对照组比较差异无统计学意义。

Objetive To investigate the clinical effect of therapy that combines vitrectomy with intravitreal anti-VEGF drug injection in patients with proliferative diabetic retinopathy.Methods Fifty eyes of 43 patients with proliferative diabetic retinopathy(PDR)diagnosed from August 2018 to May 2020 in Anhui Provincial Hospital were selected and treated with 23 G vitrectomy.50 eyes were divided into two groups,17 patients(20 eyes)in the injection group and 30 patients(26 eyes)in the control group.AntiVEGF drugs were injected into the vitreous 3 to 7 days before 23 G vitrectomy in the injection group,while 23 G vitrectomy was performed directly after admission in the control group.The operation time,intraoperative and postoperative complications and the visual acuity of the two groups were observed and analyzed.Results Intraoperative hemorrhage and the use of electrocoagulation in the injection group were significantly less than those in the control group,there was significant difference between the two groups(x^(2)=3.955,P<0.05).The incidence of recurrent vitreous hemorrhage and re-operation in the injection group was significantly lower than those in the control group,there was significant difference between the two groups(x^(2)=4.084,P<0.05).The incidence of ocular hypertension in the injection group was significantly lower than that in the control group(x^(2)=4.084,P<0.05).However,there was no significant difference in operative time between the two groups(t=0.248,P>0.05).What’s more,The use of intraocular implants in the injection group was less than that in the control group,but there was no significant difference in the number of eyes between the two groups(x^(2)=0.013,P>0.05).The rate of vision improvement during the 6 months after the 23 G vitrectomy of the injection group was higher than that of the control group,but there was no significant difference between the two groups(P>0.05).Conclusion After the above treatment,intravitreal anti-VEGF drug injection before 23 G vitrectomy in PDR patients can reduce the occurrence of intraoperative bleeding,the use rate of intraoperative electrocoagulation,and the occurrence of postoperative complications,these include rebleeding,Retinal detachment,and elevated intraocular pressure,which in turn reduce the risk of reoperation.However,there was no significant difference between the two groups in the use of intraoperative Tamponade,the operation time and the improvement of postoperative visual acuity.