OCTA对抗VEGF药物联合PPV治疗PDR疗效评价研究

Evaluation of the therapeutic effect of anti-VEGF drugs combined with PPV in the treatment of PDR using OCTA

目的 探讨光学相干断层扫描血管成像(OCTA)评估康柏西普与雷珠单抗联合玻璃体切除术(PPV)治疗增殖期糖尿病视网膜病变(PDR)效果。方法 选取2019年1月至2020年11月南昌大学附属眼科医院就诊未经治疗的增殖期糖尿病视网膜病变患者90例,按随机数字表法分为A、B、C三组,每组30例。A组PPV联合注射康柏西普治疗,B组PPV联合注射雷珠单抗组,C组单纯PPV手术治疗。对比三组手术时间、术中出血量与术后出血率,并利用OCTA评估新生血管情况,对比三组黄斑中心凹视网膜厚度(CMT)与新生血管消退情况,同时比较三组最佳矫正视力。结果 A组、B组的手术时间短于C组,术后出血率、术中出血量低于C组,差异有统计学意义(P<0.05),A组、B组的手术时间、术后出血率、术中出血量比较,差异无统计学意义(P>0.05);三组术前最佳矫正视力(BCVA)、CMT比较,差异无统计学意义(P>0.05),术后三组BCVA、CMT均明显低于术前,A组、B组BCVA、CMT低于C组,且新生血管消退率高于C组,差异有统计学意义(P<0.05);A组术后BCVA低于B组,差异有统计学意义(P<0.05);A、B组患者术后的CMT及新生血管消退率比较,差异无统计学意义(P>0.05)。结论PPV术前注射抗新生血管药物治疗PDR患者可缩短手术时间,减少术中出血,降低术后出血率,提高视力,而康柏西普注射后可更好地改善患者视力。

Objective To investigate the effectiveness of combined treatment with Conbercept or Ranibizumab and pars plana vitrectomy(PPV)in proliferative diabetic retinopathy(PDR)patients by evaluating retinal vasculature using optical coherence tomography angiography(OCTA).Methods Ninety untreated PDR patients who visited the Eye Hospital affiliated to Nanchang University between January 2019 and November 2020 were randomly assigned to groups A,B,or C.Group A received PPV combined with Conbercept injection,group B received PPV combined with Ranibizumab injection,and group C received PPV alone.Surgical time,intraoperative bleeding volume,and postoperative bleeding rates were compared among the three groups.OCTA was used to assess neovascularization,central macular thickness(CMT),and neovascularization regression.Best-corrected visual acuity(BCVA)was also compared among the three groups.Results Groups A and B had shorter surgical times than group C,and their postoperative bleeding rates and intraoperative bleeding volumes were lower than those of Group C,with statistical significance(P<0.05).No significant difference was found between groups A and B for surgical time,postoperative bleeding rate,or intraoperative bleeding volume(P>0.05).There was no significant difference in preoperative BCVA or CMT among the three groups(P>0.05).Postoperatively,BCVA and CMT decreased significantly in all three groups,and the neovascularization regression rate was higher in groups A and B than in group C,with statistical significance(P<0.05).Group A had a lower BCVA than group B postoperatively(P<0.05).There was no significant difference in postoperative CMT or neovascularization regression rate between groups A and B(P>0.05).Conclusion Preoperative injection of anti-neovascularization drugs in PDR patients undergoing PPV can shorten surgical time,reduce intraoperative bleeding,and lower postoperative bleeding rates while improving visual acuity.Conbercept injections may result in better visual outcomes compared to ranibizumab injections.