不同药物联合黄斑区激光光凝对老年糖尿病视网膜病变后黄斑水肿的影响

Different drugs combined with macular laser photocoagulation for macular edema after diabetic retinopathy in elderly patients

目的探究不同药物(曲安奈德、康柏西普)联合黄斑区激光光凝对老年糖尿病视网膜病变(DR)后黄斑水肿的影响。方法前瞻性研究,选取2020年6月至2023年6月于连云港市第一人民医院眼科就诊的70例(82眼)老年DR后黄斑水肿患者作为研究对象,采用随机数字法分为观察组(35例,42眼)和对照组(35例,40眼)。观察组男19例、女16例,年龄(73.26±4.89)岁,采用康柏西普联合黄斑区激光光凝治疗;对照组男17例、女18例,年龄(72.87±5.11)岁,采用曲安奈德联合黄斑区激光光凝治疗。对比两组患者症状改善与消退时间、治疗前后视功能相关指标[黄斑中心凹下脉络膜厚度(SFCT)、最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)]、疾病相关生化指标[血管内皮生长因子(VEGF)、人基质细胞衍生因子1(SDF-1)]、黄斑区血流密度[浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)]、疾病相关指标[脉络膜血管指数(CVI)、血清补体1q/肿瘤坏死因子相关蛋白9(CTRP9)]及不良反应发生情况。统计学方法采用t检验、χ^(2)检验。结果观察组黄斑水肿改善时间、眼底出血吸收时间、渗出吸收时间均短于对照组[(4.36±0.21)周比(5.42±0.38)周、(2.39±0.23)周比(3.42±0.33)周、(10.36±0.81)周比(12.25±1.15)周],差异均有统计学意义(t=15.733、16.463、8.637,均P<0.05)。治疗3个月后,观察组CMT、VEGF、SDF-1、CVI均低于对照组[(339.56±31.24)μm比(398.69±27.29)μm、(138.72±16.73)ng/L比(276.19±15.92)ng/L、(415.23±24.80)mg/L比(526.16±22.93)mg/L、(63.86±0.94)%比(64.97±0.61)%],BCVA、SCP、DCP、CTRP9水平均高于对照组[(0.49±0.08)比(0.34±0.07)、(39.92±2.84)%比(38.16±2.79)%、(45.96±2.71)%比(43.39±2.39)%、(113.36±14.65)μg/L比(102.45±13.29)μg/L,差异均有统计学意义(t=10.180、30.080、21.034、6.420、9.018、2.830、4.546、3.575,均P<0.05)。两组患者SFCT比较,差异无统计学意义(t=0.302,P=0.763)。治疗期间,观察组出现1例眼部干涩(单眼),对照组出现1例结膜充血(单眼),其余无明显不良反应(χ^(2)=0.001,P=0.972)。结论与曲安奈德联合黄斑区激光光凝相比,康柏西普联合黄斑区激光光凝可有效改善老年DR后黄斑水肿患者视功能,缓解其临床症状,促进视力恢复,具有良好临床疗效。

Objective To explore the clinical efficacy of triamcinolone acetonide or conbercept combined with laser photocoagulation in the treatment of macular edema after diabetic retinopathy(DR)in elderly patients.Methods Seventy elderly patients with macular edema after DR(82 eyes)treated at Department of Ophthalmology,Lianyungang First People's Hospital from June 2020 to June 2023 were selected for the prospective study,and were divided into an observation group(35 cases and 42 eyes)and a control group(35 cases and 40 eyes)by the random number table method.There were 19 males and 16 females in the observation group;they were(73.26±4.89)years old.There were 17 males and 18 females in the control group;they were(72.87±5.11)years old.The observation group took conbercept and macular laser photocoagulation.The control group took macular laser photocoagulation.The improvement and regression times of symptoms,visual function-related indicators[subfoveal choroidal thickness(SFCT),best corrected visual acuity(BCVA),and central macular thickness(CMT)],disease-related biochemical indicators[vascular endothelial growth factor(VEGF)and stromal cell-derived factor-1(SDF-1)],macular blood flow densities[superficial capillary plexus(SCP)and deep capillary plexus(DCP)],and disease-related indicators[choroidal vascular index(CVI)and serum complement 1q/tumor necrosis factor-associated protein 9(CTRP9)]before the treatment and after 3 months'treatment,and incidences of adverse reactions were compared between groups by t andχ^(2)tests.Results The macular edema improvement time,fundus bleeding absorption time,and effusion absorption time in the observation group were shorter than those in the control group[(4.36±0.21)weeks vs.(5.42±0.38)weeks,(2.39±0.23)weeks vs.(3.42±0.33)weeks,and(10.36±0.81)weeks vs.(12.25±1.15)weeks],with statistical differences(t=15.733,16.463,and 8.637;all P<0.05).After 3 months'treatment,the CMT,VEGF,SDF-1,and CVI in the observation group were lower than those in the control group[(339.56±31.24)μm vs.(398.69±27.29)μm,(138.72±16.73)ng/L vs.(276.19±15.92)ng/L,(415.23±24.80)mg/L vs.(526.16±22.93)mg/L,and(63.86±0.94)%vs.(64.97±0.61)%];the levels of BCVA,SCP,DCP,and CTRP9 in the observation group were higher than those in the control group[(0.49±0.08)vs.(0.34±0.07),(39.92±2.84)%vs.(38.16±2.79)%,(45.96±2.71)%vs.(43.39±2.39)%,and(113.36±14.65)μg/L vs.(102.45±13.29)μg/L];there were statistical differences(t=10.180,30.080,21.034,6.420,9.018,2.830,4.546,3.575;all P<0.05).There was no statistical difference in SFCT between the two groups(t=0.302;P=0.763).During the treatment,1 case of dry eyes(single eye)occurred in observation group,and 1 case of conjunctival congestion(single eye)occurred in control group;the rest had no obvious adverse reactions(χ^(2)=0.001;P=0.972).Conclusions Compared with macular laser photocoagulation combined with triamcinolone acetonide,macular laser photocoagulation combined with conbercept has better clinical efficacy for elderly patients with macular edema after DR,and the latter one can better promote the recovery of visual function.In addition,it has a positive effect on the visual acuity,and can alleviate the clinical symptoms.