广泛视网膜激光光凝术联合康柏西普治疗糖尿病视网膜病变的效果观察

Observation on the efficacy of panretinal photocoagulation combined with conbercept in the treatment of stageⅡ-Ⅳdiabetic retinopathy

目的观察广泛视网膜激光光凝术(PRP)联合玻璃体内注射康柏西普治疗Ⅱ~Ⅳ期糖尿病视网膜病变(DR)的效果。方法前瞻性随机对照研究。纳入2020年1月至2023年1月平煤神马集团总医院收治的Ⅱ~Ⅳ期DR患者256例(256只眼),按随机数字表法分为对照组和观察组,每组各128例。对照组行单独PRP治疗,观察组予以玻璃体内注射康柏西普,术后1周行PRP治疗。比较两组PRP术前和术后1、6个月两组患者黄斑中心区厚度(CMT)、最佳矫正视力(BCVA,logMAR)、眼压以及应用彩色多普勒超声成像检测眼部血流参数[舒张末期血流速度(EDV)、阻力指数(RI)、睫状后动脉收缩期峰值血流速度(PSV)]水平的变化,并记录患者并发症的发生情况。结果观察组PRP治疗后1、6个月CMT值为(275.63±10.00)及(222.70±8.18)μm,均低于对照组的(285.69±12.37)及(256.94±9.63)μm(t=11.22、13.03,P=0.006、0.011);BCVA为0.78±0.28及0.64±0.18,均较对照组的0.91±0.30及0.78±0.29改善更好(t=1.15、1.26,P=0.009、0.013);两组PRP术前及术后1、6个月眼压比较差异无统计学意义(P>0.05);观察组治疗1、6个月后PSV为(12.36±0.85)及(13.44±0.91)cm/s、EDV为(3.91±0.50)及(4.20±0.63)cm/s,均高于对照组的PSV[(12.01±0.51)及(13.00±0.23)cm/s]和EDV[(3.74±0.41)及(4.00±0.50)cm/s](t=0.86、0.96,P=0.014、0.016);RI为(0.66±0.04)及(0.62±0.03)cm/s,均低于对照组的(0.70±0.05)及(0.68±0.04)cm/s(t=1.11、1.24,P=0.011、0.020);两组的并发症发生率分别为14.06%(18/128)和4.69%(6/128),观察组低于对照组(χ^(2)=6.62,P=0.010)。结论PRP联合玻璃体内注射康柏西普治疗Ⅱ~Ⅳ期DR,可有效提高视力,降低CMT,改善脉络膜血流量,减少并发症。

Objective To observe the efficacy of panretinal photocoagulation(PRP)combined with intravitreal injection of conbercept in the treatment of stageⅡ-Ⅳdiabetic retinopathy(DR).Methods This was a prospective randomized controlled study.A total of 256 patients(256 eyes)with DR in the General Hospital of Pingmei Group from Jan.2020 to Jan.2023 were collected.All cases were divided into two groups based on random number table methods,with 128 cases in each group.The control group was treated with PRP,and the observation group was treated with intravitreal injection of conbercept for 1 weeks before PRP.Changes of central macular thickness(CMT),best corrected visual acuity(BCVA,logMAR),intraocular pressure and eye blood flow parameters end-diastolic blood velocity(EDV),resistance index(RI),and peak systolic blood velocity(PSV)detected by color Doppler ultrasound were compared between the two groups before and at 1 and 6 months after PRP.The occurrence of complications was recorded.Results The CMT of the observation group at 1 and 6 months after PRP treatment were(275.63±10.00)and(222.70±8.18)μm,which were lower than the(285.69±12.37)μm and the(256.94±9.63)μm of the control group(t=11.22,13.03;P=0.006,0.011).BCVA was 0.78±0.28 and 0.64±0.18,which were better than the 0.91±0.30 and the 0.78±0.29 of the control group(t=1.15,1.26;P=0.009,0.013).There was no significant difference in intraocular pressure between the two groups before operation and at 1 and 6 months after PRP(P>0.05).In the observation group,PSV was(12.36±0.85)and(13.44±0.91)cm/s,and EDV was(3.91±0.50)and(4.20±0.63)cm/s at 1 and 6 months after operation,respectively.PSV[(12.01±0.51)and(13.00±0.23)cm/s]and EDV[(3.74±0.41)and(4.00±0.50)cm/s]in the control group were significantly higher than those in the control group(t=0.86,0.96;P=0.014,0.016).The RI of the observation group was(0.66±0.04)and(0.62±0.03)cm/s at 1 and 6 months after operation,which were lower than the(0.70±0.05)and the(0.68±0.04)cm/s in the control group(t=1.11,1.24;P=0.011,0.020).The incidence of complications in the observation group[4.69%(6/128)]was lower than that in the control group[14.06%(18/128)](χ^(2)=6.62,P=0.010).Conclusion PRP combined with intravitreal injection of conbercept in the treatment of DR can effectively improve visual acuity,reduce CMT,improve choroidal blood flow,and reduce complications.