玻切及抗VEGF药物治疗伴水肿及渗出的糖尿病性视网膜病变

Efficacy of vitrectomy and anti-VEGF drug for the treatment of diabetic retinopathy complicated with diffuse retinal edema and massive subretinal hard exudates

目的评价玻璃体切除术及抗VEGF药物治疗伴后极部弥漫性水肿及大片硬性渗出的糖尿病性视网膜病变的效果。方法前瞻性研究。纳入河南省人民医院2017年1月至2018年12月30例伴后极部弥漫性水肿及大片硬性渗出的糖尿病性视网膜病变者(36眼),患者均接受玻璃体内注射抗VEGF药物后行玻璃体切除联合视网膜前膜剥除术,观察术后效果。结果随访6~24个月:视力提高者30眼(83.33%),术后视力均较术前提高(F=64.316,P<0.05)。渗出完全吸收32眼(88.89%)。7眼(19.44%)视力低于0.05,原因为黄斑部渗出及水肿未完全吸收、黄斑中心区视网膜下瘢痕形成及黄斑部视网膜前膜形成等。结论玻璃体切除、视网膜前膜剥除及抗VEGF药物治疗伴后极部弥漫性水肿和大片硬性渗出的糖尿病性视网膜病变有效。

Objective To evaluate the clinical efficacy of vitrectomy and anti-VEGF drug for the treatment of diabetic retinopathy complicated with diffuse retinal edema and massive subretinal hard exudates.Methods This was a prospective study.Thirty-six eyes of 30 patients with diabetic retinopathy complicated with diffuse retinal edema and massive subretinal hard exudates were recruited from Jan.2017 to Dec.2018 in Henan Provincial People’s Hospital.All patients received pars plana vitrectomy,epiretinal membrane peeling after intravitreal injection of anti-VEGF treatment.The efficacy after surgery were observed.Results The follow-up time was from 6 to 24 months.At the end of follow-up time,BCVA improved in 30 eyes(83.33%).The postoperative visual acuity was better than that before operation(F=64.316,P<0.05).Hard exudate completely absorbed in 32 eyes(88.89%).BCVA were less than 0.05 in 7 eyes(19.44%),because the macular hard exudates were not absorbed completely,macular subretinal scar formed after hard exudates absorption,and macular preretinal membrane formed.Conclusion Vitrectomy,epiretinal membrane peeling,pre-operative and post-operative anti-VEGF therapy are effective for the treatment of patients with diffuse diabetic retinal edema and massive subretinal hard exudates.