玻璃体注射康柏西普玻璃体切除术治疗严重增生性糖尿病视网膜病变的效果

Efficacy of vitreous injection of conbercept assisted vitrectomy for severe proliferative diabetic retinopathy

目的观察玻璃体内注射康柏西普(IVC)辅助微创玻璃体切除术(PPV)治疗严重增生性糖尿病性视网膜病变(PDR)的效果。方法前瞻性队列研究。焦煤中央医院2020年1月至2021年1月严重PDR 94例, 随机分为对照组与观察组, 各47例。对照组行单纯23G PPV治疗, 观察组在23G PPV术前3 d行玻璃体内注射康柏西普。术后随访6个月, 比较两组患者术中情况、视力、眼压、黄斑区中央区视网膜厚度(CMT)、N1波潜伏期波幅、血管内皮生长因子(VEGF)及胎盘生长因子(PIGF)水平, 并对手术的安全性进行评价。结果观察组手术时间、术中出血例数、术中行电凝止血例数、医源性视网膜裂孔发生率、激光点数、硅油填充例数均少于对照组(均P<0.05), 两组摘除晶状体例数比较差异无统计学意义(P>0.05)。术后6个月观察组的BVCA、CMT、N1波潜伏期波幅、VEGF以及PIGF等均较对照组更低(t=9.30、2.72、5.62、2.35、3.68, P<0.001、0.008、<0.001、0.021、<0.001), 两组术后6个月眼压比较差异无统计学意义(P>0.05)。观察组术后6个月的并发症发生率为4.26%(2/47), 对照组为25.33%(12/47), 观察组较对照组更低(χ^(2)=8.39, P=0.004)。结论 IVC辅助PPV治疗严重PDR可缩短手术时间, 降低手术难度, 提高患者视力功能并调节细胞因子水平, 较安全。

Objective To observe the efficacy of intravitreal injection of conbercept(IVC)assisted minimally invasive vitrectomy(PPV)in the treatment of severe proliferative diabetic retinopathy(PDR).Methods This was a prospective cohort study.A total of 94 patients with severe PDR in the Central Hospital of Jiaozuo Coal Industry(Group)Co.,LTD from Jan.2020 to Jan.2021 were selected and randomly divided into the control group and the observation group,47 cases in each group.The control group was treated with 23G PPV,while the observation group was intravitreal injected with conbercept at 3 days before 23G PPV.The intraoperative conditions,the best corrected visual acuity(BCVA),intraocular pressure(IOP),macular foveal retinal thickness(CMT),N1 latency amplitude,vascular endothelial growth factor(VEGF)and placental growth factor(PIGF)of the two groups were compared.The follow-up time was 6 months after surgery.The safety of surgery was evaluated.Results The operation time,the case of intraoperative bleeding and electrocoagulation,the incidence of iatrogenic retinal hole,laser points,silicone oil tamponade in the observation group were less than those in the control group(all P<0.05).There was no significant difference in the number of lens removal cases between the two groups(P>0.05).At 6 months after operation,the BVCA,CMT,N1 latency amplitude,VEGF and PIGF of the observation group were lower than those of the control group(t=9.30,2.72,5.62,2.35,3.68;P<0.001,0.008,<0.001,0.021,<0.001).There was no significant difference in IOP between the two groups 6 months after operation(P>0.05).The complication rate of the observation group was 4.26%(2/47)and that of the control group was 25.33%(12/47),which was lower than that of the control group(χ^(2)=8.39,P=0.004).Conclusion IVC assisted PPV in the treatment of severe PDR can shorten the operation time,reduce the difficulty of operation,improve the visual function of patients and regulate the level of cytokines,with a high safety factor.