25G玻璃体切割术联合不同抗VEGF药物治疗PDR的疗效比较

Curative effect of 25G vitrectomy combined with different anti-VEGF drugs on proliferative diabetic retinopathy

目的:探讨25G玻璃体切割术联合不同抗血管内皮生长因子(VEGF)药物治疗增殖性糖尿病视网膜病变(PDR)患者的效果观察。方法:选择2018-07/2020-07本院收治的PDR患者作为研究对象,所有患者均行25G玻璃体切割术,术前7d给予抗VEGF药物,根据治疗方法分为雷珠单抗组(31例31眼)、康柏西普组(30例30眼)、阿柏西普组(29例29眼)。于玻璃体腔注射抗VEGF药物前及行玻璃体切割术时采集房水检测VEGF、色素上皮衍生因子(PEDF)水平,于术前及术后3、6mo时测定最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)。结果:各组患者玻璃体腔注药后房水VEGF水平显著降低(P<0.05),PEDF水平升高(P<0.05),三组组间比较均无差异(P>0.05)。三组手术时间、术中出血、医源性裂孔发生情况比较均无差异(P>0.05)。三组患者术后3、6mo时BCVA显著优于术前(P<0.05),CMT显著低于术前(P<0.05),三组组间比较均无差异(P>0.05)。结论:PDR患者玻璃体切割术前玻璃体腔注射抗VEGF药物可降低房水内血管相关因子的表达;雷珠单抗、康柏西普、阿柏西普联合玻璃体切割术治疗PDR的临床疗效及安全性相当。

AIM:To explore the curative effect of 25 G vitrectomy combined with different anti-vascular endothelial growth factor(VEGF)drugs on patients with proliferative diabetic retinopathy(PDR).METHODS:PDR patients admitted to the hospital between July 2018 and July 2020 were enrolled as the research subjects,and they all underwent 25 G vitrectomy and were administrated anti-VEGF drugs at 7 d before surgery.They were divided into ranibizumab group(31 cases,31 eyes),conbercept group(30 cases,30 eyes)and aflibercept group(29 cases,29 eyes)according to different treatment.The aqueous humor was collected before intravitreal injection and during vitrectomy to detect levels of VEGF and pigment epithelial-derived factor(PEDF).The best corrected visual acuity(BCVA)and central macular thickness(CMT)were detected before surgery and at 3 and 6 mo after surgery.RESULTS:After intravitreal injection,level of VEGF in aqueous humor was significantly decreased in all groups(P<0.05),while PEDF level was increased in all groups(P<0.05),but there was no significant difference among the three groups(P>0.05).There was no significant difference in operation time,the occurrence of intraoperative hemorrhage and iatrogenic retinal breaks among the three groups(P>0.05).BCVA among the three groups at 3 and 6 mo after surgery was significantly better than that before surgery(P<0.05),and CMT was significantly thinner than that before surgery(P<0.05),but there was no significant difference among the three groups(P>0.05).CONCLUSION:Intravitreal injection of anti-VEGF drugs before vitrectomy in PDR patients can reduce the expressions of vascular-related factors in aqueous humor.The clinical effect and safety of vitrectomy combined with ranibizumab,conbercept and aflibercept,respectively,are comparable in the treatment of PDR.