Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage

AIM:To assess the clinical efficacy and safety of combining panretinal photocoagulation(PRP)with intravitreal conbercept(IVC)injections for patients with high-risk proliferative diabetic retinopathy(HR-PDR)complicated by mild or moderate vitreous hemorrhage(VH),with or without diabetic macular edema(DME).METHODS:Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study.Upon establishing the patient’s diagnosis,an initial IVC was performed,followed by prompt administration of PRP.In cases who significant bleeding persisted and impeded the laser operation,IVC was sustained before supplementing with PRP.Following the completion of PRP,patients were meticulously monitored for a minimum of six months.Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography(FFA)results.Therapeutic effect and the incidence of adverse events were observed.RESULTS:Out of 42 patients(74 eyes),29 were male and 13 were female,with a mean age of 59.17±12.74y(33-84y).The diabetic history was between 1wk and 26y,and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y.The affected eye received 2.59±1.87(1-10)IVC injections and underwent 5.5±1.02(4-8)sessions of PRP.Of these,68 eyes received PRP following 1 IVC injection,5 eyes after 2 IVC injections,and 1 eye after 3 IVC injections.Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment,with resolution of DME in 51 eyes 3-48wk after initial treatment.A newly developed epiretinal membrane was noted in one eye.Visual acuity significantly improved in 25 eyes.No complications such as glaucoma,retinal detachment,or endophthalmitis were reported.CONCLUSION:The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.

Efficacy comparison of multipoint and single point scanning panretinal laser photocoagulation in non-proliferative diabetic retinopathy treatment

BACKGROUND Non-proliferative diabetic retinopathy(NPDR)poses a significant challenge in diabetes management due to its microvascular changes in the retina.Laser photocoagulation,a conventional therapy,aims to mitigate the risk of progressing to proliferative diabetic retinopathy(PDR).AIM To compare the efficacy and safety of multi-spot vs single-spot scanning panretinal laser photocoagulation in NPDR patients.METHODS Forty-nine NPDR patients(86 eyes)treated between September 2020 and July 2022 were included.They were randomly allocated into single-spot(n=23,40 eyes)and multi-spot(n=26,46 eyes)groups.Treatment outcomes,including bestcorrected visual acuity(BCVA),central macular thickness(CMT),and mean threshold sensitivity,were assessed at predetermined intervals over 12 months.Adverse reactions were also recorded.RESULTS Energy levels did not significantly differ between groups(P>0.05),but the multi-spot group exhibited lower energy density(P<0.05).BCVA and CMT improvements were noted in the multi-spot group at one-month posttreatment(P<0.05).Adverse reaction incidence was similar between groups(P>0.05).CONCLUSION While energy intensity and safety were comparable between modalities,multi-spot scanning demonstrated lower energy density and showed superior short-term improvements in BCVA and CMT for NPDR patients,with reduced laser-induced damage.

Change in subfoveal choroidal thickness after argon laser panretinal photocoagulation

AIMTo evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy.

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

AIM：To evaluate the efficacy and safety of intravitreal ranibizumab（IVR）with panretinal photocoagulation（PRP）followed by trabeculectomy compared with Ahmed glaucoma valve（AGV）implantation in neovascular glaucoma（NVG）.METHODS：This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included：diabetic retinopathy（25 eyes）,and retinal vein occlusion（20 eyes）.All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities（BCVA）were converted to the logarithms of the minimum angle of resolution（log MAR）for the statisitical analyses.Intraocular pressure（IOP）,the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS：A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery（F=545.468,P〈0.05）,and the mean postoperative log MAR BCVA was also significantly improved（F=10.964,P〈0.05）with no significant difference between two groups.CONCLUSION：It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR＋AGV implantation＋PRP and IVR＋trabeculectomy＋PRP in eyes with NVG.

Effects of intravitreal conbercept before panretinal photocoagulation on lipid exudates in diabetic macular documented by optical coherence tomography

AIM: To evaluate the effects of intravitreal conbercept(IVC) as adjunctive treatments before panretinal photocoagulation(PRP) to decrease hyperreflective dots(HRDs) in Chinese proliferative diabetic retinopathy(PDR) patients. METHODS: Fifty-nine enrolled patients were categorized into 2 groups: single dose IVC(0.5 mg/0.05 m L) 1 wk before PRP(Plus group) or PRP only(PRP group). Six months later, we measured the best corrected visual acuity(BCVA), central macula thickness(CMT) by optical coherence tomography and counted the number of HRDs in different retina layers. RESULTS: The average CMT significantly decreased in Plus group but increased in PRP group. The average BCVA in the Plus group was also significantly better than that in the PRP group. Total HRDs decreased in the Plus group but increased in PRP group significantly. IVC pre-treatment has beneficial effects on reducing HRDs forming in the inner retina layer while the PRP alone increased the HRDs in the outer retina layer. CONCLUSION: IVC is a promising adjunctive treatment to PRP in the treatment of PDR. Single dose IVC one week before PRP is suggested to improve retina blood-retina barrier, decrease lipid exudate and inhibit HRDs development in PDR.

Simultaneous pars plana vitrectomy,panretinal photocoagulation,cryotherapy,and Ahmed valve implantation for neovascular glaucoma

AIM:To describe and evaluate the efficacy of Ahmed glaucoma valve implantation(AGV)combined with pars plana vitrectomy(PPV)in a single surgical act for the treatment of advanced neovascular glaucoma(NVG).METHODS:Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV,AGV,and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period(2005-2018).Preoperative,intraoperative and postoperative data at day 1 and months 1,3,6,21,and 24 were systematically collected.Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment.RESULTS:Main indications for surgery were NVG secondary to proliferative diabetic retinopathy(39.2%)and central retinal vein occlusion(37.3%).Mean(±SD)preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12 mo and 15.8±9.1 mm Hg at 24 mo of follow up.Cumulative incidence of success of IOP control was 76.0%at first postoperative month,reaching 88.3%at 6 mo.Prevalence of successful IOP control at long term was 74.4%at 12 mo and 71.4%at 24 mo.Eye evisceration for unsuccessful NVG management was required in 1 case(2.0%).CONCLUSION:Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.

Efficacy of intravitreal conbercept combined with panretinal photocoagulation for severe nonproliferative diabetic retinopathy without macular edema

AIM: To assess efficacy of intravitreal conbercept(IVC) injection in combination with panretinal photocoagulation(PRP) vs PRP alone in patients with severe nonproliferative diabetic retinopathy(SNPDR) without macular edema(ME).METHODS: Forty-eight patients with SNPDR without ME(56 eyes) were divided into the PRP group and IVC+PRP group(the pulse group) in this retrospective clinical study. Conbercept was intravitreally administered to patients in the pulse group 1 wk before treatment with PRP and followed up for 1, 3, and 6 mo. The best-corrected visual acuity(BCVA, log MAR), center foveal thickness(CFT), visual acuity(VA) improvement, and adverse reactions were compared between groups.RESULTS: In the PRP group, the BCVA reduced at 1 and 3 mo before improving at 6 mo. In the pulse group, baseline BCVA decreased continuously at 1 mo, increased at 3 and 6 mo. BCVA in the pulse group was better than that in the PRP group at 1, 3, and 6 mo. There was an increase in CFT in the PRP group during follow-up compared with baseline. In the pulse group, CFT was increased at 1 mo relative to baseline, steadily decreased to the baseline level at 3 and 6 mo. There was a more significant reduction in CFT in the pulse group during follow-up compared with the PRP group. The effective rates of VA in the PRP and the pulse groups were 81.48% and 100%, respectively. CONCLUSION: As PRP pretreatment, a single dose of IVC administration has beneficial effects for preventing PRPinduced foveal thickening and increasing VA in patients with SNPDR without ME.

PRP对糖尿病视网膜病变患者神经纤维层厚度及视野的影响

目的:观察经全视网膜激光光凝(PRP)治疗的重度非增生型糖尿病视网膜病变(NPDR)患者视网膜神经纤维层(RNFL)厚度变化和视野缺失情况及相关性。方法:前瞻性临床研究。选取2017-01/2018-03经我院眼科确诊的重度NPDR患者35例52眼(光凝组,常规药物治疗的同时行PRP治疗),另选取同期入院、年龄和性别等相匹配的重度NPDR患者35例52眼作为对照组(常规药物治疗)。随访1a,分析比较两组患者最佳矫正视力(BCVA)、RNFL厚度和视野变化情况。结果:治疗后1a,光凝组患者BCVA无明显改善(P>0.05),而对照组BCVA明显降低(P<0.05);光凝组患者颞侧RNFL厚度无明显变化(74.5±13.7μm vs 70.8±11.3μm,P>0.05),其余象限RNFL和平均RNFL厚度均较治疗前变薄(均P<0.05),且颞侧神经纤维对应视野MS值无明显变化(22.5±8.7dB vs 20.8±7.2dB,P>0.05),其余象限和平均MS值均较治疗前降低(均P<0.05)。光凝组患者治疗前后鼻侧、鼻上方、颞上方、颞侧、颞下方、鼻下方及平均RNFL厚度变化值与神经纤维所对应视野MS变化值呈正相关或无相关性。结论:PRP能有效控制重度NPDR进一步发展,维持患者视力,但PRP对RNFL和视野的损伤作用不容忽视。

早期PRP与复方樟柳碱颞浅动脉旁穴位注射治疗RR的疗效

目的:观察早期视网膜激光光凝(PRP)联合复方樟柳碱颞浅动脉旁皮下注射治疗放射性视网膜病变(RR)的临床疗效。方法:在我院确诊为因鼻咽癌外照射后发生RR的患者21例41眼,早期行双眼视网膜激光光凝联合复方樟柳碱颞浅动脉旁穴位注射治疗,观察治疗后3mo最佳矫正视力(BCVA)、毛细血管无灌注区变化、视网膜新生血管及并发症情况。结果:治疗后观察3mo,视力提高6眼(14.6%),视力不变31眼(75.7%),下降4眼(9.7%)。2眼虹膜新生血管消退,1眼行睫状体光凝术;9眼(75%)视网膜新生血管消退;22眼(68.7%)原视网膜无灌注区消失,7眼(21.8%)原视网膜无灌注区(NPA)缩小>5个DA,总有效率90.5%。1眼发生玻璃体出血,未见视盘及虹膜新生血管和新生血管性青光眼等并发症以及与治疗相关的并发症。结论:早期PRP与复方樟柳碱颞浅动脉旁穴位注射治疗是有效的、合理的中西医结合治疗方法。

雷珠单抗辅助玻璃体切割和PRP联合小梁切除术治疗NVG的疗效

目的:观察雷珠单抗辅助玻璃体切割+全视网膜光凝(PRP)+小梁切除术治疗新生血管性青光眼(NVG)的临床疗效。方法:回顾性分析2017-03/2018-10收治的NVG患者44例44眼,采用玻璃体腔内注射雷珠单抗+玻璃体切割+PRP+小梁切除手术治疗的患者22例22眼(A组),采用玻璃体腔内注射雷珠单抗+小梁切除+PRP治疗的患者22例22眼(B组)。术后随访6mo,观察患者视力、眼压、眼压控制率、新生血管及并发症等情况。结果:治疗前两组患者眼压无差异(46.2±9.41mmHg vs 49.1±10.15mmHg,P>0.05),治疗后1wk,1、6mo A组患者眼压均低于B组(P<0.05)。治疗后6mo,A组视力、眼压控制率(95%)、新生血管消退情况(91%)均优于B组(P<0.05),但随访期间两组患者并发症发生率无差异(P>0.05)。结论:雷珠单抗辅助玻璃体切割+PRP+小梁切除术治疗NVG安全有效,可稳定持久地控制眼压,改善部分患者视力。

康柏西普在PRP治疗SNPDR合并DME的给药时机选择

目的:探讨玻璃体腔内注射康柏西普(IVC)联合全视网膜光凝(PRP)治疗合并黄斑水肿(DME)的重度非增殖性糖尿病性视网膜病变(SNPDR)患者的给药时机。方法:前瞻性病例对照研究。选取2017-05/2018-10于我院确诊的合并DME的SNPDR患者85例85眼,随机分为三组:对照组29眼仅予以PRP治疗;IVC组28眼在IVC后1wk予以PRP;PRP组28眼在PRP后1wk予以IVC。随访12mo,观察治疗前及治疗后1、3、6、12mo最佳矫正视力(BCVA)、黄斑区中心凹厚度(CMT)变化,记录IVC频次。结果:三组患者治疗后的BCVA较治疗前改善,CMT较治疗前降低(P<0.05)。治疗后IVC组和PRP组BCVA优于对照组,CMT低于对照组(P<0.05)。治疗后3mo,ICV组BCVA(0.24±0.18,LogMAR)下降均较PRP组(0.38±0.29,LogMAR)明显(P<0.05)。治疗后1、3mo,ICV组CMT(313.89±61.69、287.64±43.94μm)下降均较PRP组(347.50±56.55、318.04±49.33μm)明显(P<0.05)。IVC给药频次为IVC组3.07±1.33次、PRP组3.93±1.60次(P<0.05)。结论:治疗合并DME的SNPDR患者,IVC联合PRP治疗优于单纯PRP治疗,且在PRP治疗之前予以抗VEGF药物,短期内BCVA提高、黄斑水肿减轻,长期观察可减少IVC次数,降低感染风险,减轻经济负担。

PRP联合玻璃体腔注射康柏西普治疗重度NPDR对视神经纤维层厚度的影响

目的比较分析玻璃体腔注射康柏西普联合全视网膜激光光凝术(PRP)以及单纯PRP治疗重度非增生性糖尿病视网膜病变(NPDR)对视盘周围视网膜神经纤维层(RNFL)厚度的影响。方法回顾性病例对照研究。分析2019年1月至6月我院重度NPDR患者需行PRP治疗的60例(60只眼),随机分为实验组30例(30只眼)(PRP治疗前1周进行玻璃体腔注射康柏西普0.05 ml)及对照组30例30只眼(直接进行PRP),分析两组患者PRP治疗前和治疗后4周、6个月其上方、下方、鼻侧、颞侧RNFL及全周RNFL的平均厚度。结果两组治疗前、治疗后4周及6个月比较,RNFL厚度各象限及全周平均差异有统计学意义(P<0.001);与治疗前比较,治疗后4周两组RNFL厚度各象限及全周平均均增厚,对照组RNFL厚度增加有统计学意义(P<0.05),而实验组厚度增加差异无统计学意意义(P>0.05);与治疗前比较,治疗后6个月两组厚度各象限及全周平均均变薄,两组差异均有统计学意义(P<0.05),两组RNFL厚度比较差异无统计学意义(P>0.05)。结论PRP联合玻璃体腔注射康柏西普治疗重度NPDR短期内可以减轻对患者视神经纤维层厚度的影响,显著提高了PRP的疗效和安全性。

IVA+PRP治疗增殖性糖尿病视网膜病变的疗效及对视网膜各层次厚度、视力的影响

目的 针对增殖性糖尿病视网膜病变者应用玻璃体腔注射阿柏西普(intravitreous injection of arbacicept, IVA)、全视网膜光凝(panretinal photocoagulation, PRP)的疗效及对视网膜各层次厚度、视力的影响。方法 方便选取2021年9月—2022年9月泰州市中医院收治的96例增殖性糖尿病视网膜病变患者作为研究对象,以随机数表法分为观察组(48例,IVA+PRP治疗)与对照组(48例,PRP治疗),比较两组视网膜各层次厚度、中心黄斑厚度、最佳矫正视力、血清指标、治疗效果、不良事件发生率。结果 术前及术后30 d,两组黄斑区视网膜神经纤维层、神经节细胞层、内丛状层厚度比较,差异无统计学意义(P>0.05)。术前,两组中心黄斑厚度、最佳矫正视力比较,差异无统计学意义(P>0.05);术后30 d,观察组中心黄斑厚度、最佳矫正视力均低于对照组,差异有统计学意义(P<0.05)。术前,两组血清同型半胱氨酸、血清视黄醇结合蛋白4水平比较,差异无统计学意义(P>0.05);术后30 d,观察组血清同型半胱氨酸、血清视黄醇结合蛋白4水平均较对照组低,差异有统计学意义(P<0.05)。观察组治疗有效率97.92%高于对照组83.33%,差异有统计学意义(χ^(2)=4.512,P<0.05)。两组不良事件发生率比较,差异无统计学意义(P>0.05)。结论 对增殖性糖尿病视网膜病变患者实行IVA+PRP治疗,能有效改善中心黄斑厚度,提升其最佳矫正视力,调节其血清指标,其临床治疗效果更理想,可推广。

康柏西普联合PRP治疗缺血型CRVO引起新生血管性青光眼的效果及对房水Klotho和Endothelin-1的影响

目的探讨康柏西普联合全视网膜光凝(PRP)治疗缺血型视网膜中央静脉阻塞(CRVO)引起新生血管性青光眼(NVG)的效果及对房水Klotho和Endothelin-1的影响。方法选取2019年12月—2020年12月80例缺血型CRVO引起的NVG(80只眼),根据治疗方法不同分为对照组和研究组,每组40例(40只眼)。对照组采用PRP治疗,研究组采用康柏西普联合PRP治疗。对比两组综合疗效、不良事件及复发情况。比较两组治疗前后眼压和最佳矫正视力(BCVA),房水Klotho、Endothelin-1、血管内皮生长因子(VEGF)、血小板反应蛋白-1(TSP-1)、细胞色素C(CytC)、线粒体融合蛋白1(Mfn1)水平,以及视网膜中央动脉舒张末期血流速度(EDV)、收缩期峰值血流速度(PSA)。结果研究组总有效率高于对照组(P<0.05)。治疗前、治疗后4和8周,两组眼压及房水Endothelin-1、VEGF、TSP-1、CytC水平呈降低趋势,BCVA、房水Klotho和Mfn1水平、视网膜中央动脉EDV和PSA呈升高趋势;且研究组治疗后4、8周上述指标降低和升高程度均优于对照组(P<0.05)。研究组不良事件发生率低于对照组(P<0.05)。两组复发率比较差异无统计学意义(P>0.05)。结论采用康柏西普联合PRP治疗缺血型CRVO引起NVG,能显著提高治疗效果,进一步提高患者视力水平,抑制新生血管生成,改善房水Klotho、Endothelin-1水平。

雷珠单抗玻璃体腔注射联合复合式小梁切除术及PRP治疗NVG有效性的Meta分析

目的:系统评价雷珠单抗玻璃体腔注射联合复合式小梁切除及视网膜光凝术(PRP)与复合式小梁切除术联合PRP治疗新生血管性青光眼(NVG)的有效性和安全性。方法:检索万方数据库、中国知网(CNKI)、PubMed、EMbase、中国生物医学文献服务系统(CBM)、Clinicalkey、Cochrane Library数据库,查找自建库至2022-07-20试验组为雷珠单抗玻璃体腔注射联合复合式小梁切除术及PRP治疗NVG,对照组为复合式小梁切除术联合PRP治疗NVG的临床研究,同时查阅相关参考文献。提取最佳矫正视力、眼压、并发症发生情况、手术成功率进行分析。结果:本研究共纳入8篇临床研究,NVG患者864例864眼。Meta分析结果提示,试验组患者术后1wk,1、3mo时眼压较对照组下降更低(术后1wk:MD=-4.00,95%CI:-4.62~-3.38,P<0.05;术后1mo:MD=-4.11,95%CI:-4.66~-3.56,P<0.05;术后3mo:MD=-4.58,95%CI:-5.61~-3.55,P<0.05);试验组患者术后1mo时最佳矫正视力优于对照组(MD=0.17,95%CI:0.11~0.23,P<0.05),但两组患者术后1wk时无差异(MD=0.08,95%CI:-0.13~0.29,P=0.47);试验组患者术后并发症发生更少(OR=0.30,95%CI:0.18~0.52,P<0.05),手术成功率更高(OR=5.15,95%CI:2.78~9.53,P<0.05)。结论:雷珠单抗玻璃体腔注射联合复合式小梁切除术及PRP治疗NVG可降低眼压、改善视力,手术成功率优于复合式小梁切除术联合PRP。

玻璃体腔注射雷珠单抗联合小梁切除术及PRP治疗新生血管性青光眼

目的:观察玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝(panretinal photocoagulation,PRP)治疗新生血管性青光眼(NVG)的中期临床疗效。方法:回顾分析我院2015-01/2017-03间收治的21例21眼新生血管性青光眼病例的临床资料,治疗上均先行玻璃体腔雷珠单抗注射,后行5-氟尿嘧啶联合下的小梁切除术及术后行全视网膜光凝。随访6mo观察治疗前后患者眼内压(intraocular pressure,IOP)、视力、虹膜及房角新生血管、抗青光眼药物的应用、术后的并发症等。结果:患者随访至少6mo。21例患者术后眼压均得到了有效控制,患者术前平均眼压为53. 17±10. 52mmHg,术后6mo复查平均眼压为18. 50±3. 51mmHg,与术前眼压比较,差异有统计学意义(P=0. 001)。术后视力均有一定程度提高。3眼出现前房出血及玻璃体出血情况,予保守治疗后消退。患者虹膜及房角新生血管明显消退。结论:玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的中期疗效稳定。

抗VEGF、PRP对增生性糖尿病性视网膜病变疗效的Meta分析

目的 评估抗血管内皮生长因子(vascular endothelial growth factor,VEGF)单独治疗、全视网膜激光光凝(panretinal photocoagulation,PRP)及联合治疗对增生性糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)的疗效。方法 检索Pubmed、The Cochrane Library、中国知网,选取符合的随机对照研究(randomized controlled trial,RCT)进行数据提取,采用改良Jadad量表评价所纳入研究的质量,使用Review Manager软件(版本5.4)进行Meta分析。结果 共纳入8篇RCT。对于视力提高程度,抗VEGF优于PRP,差异有统计学意义[MD=3.87,95%CI(2.32,5.41),P<0.000 01],抗VEGF优于联合治疗,差异无统计学意义[MD=2.20,95%CI(-0.38,4.78),P=0.1],联合治疗优于PRP,差异有统计学意义[MD=5.47,95%CI(2.63,8.31),P=0.000 2]。新生血管消退比较,抗VEGF优于PRP,但差异无统计学意义[OR=1.17,95%CI(0.73,1.88),P=0.51],联合治疗优于抗VEGF治疗,但差异无统计学意义[OR=0.43,95%CI(0.15,1.24),P=0.12],联合治疗优于PRP,差异有统计学意义[OR=0.32,95%CI(0.13,0.76),P=0.01]。结论 与PRP治疗相比,单独抗VEGF及联合疗法更有利于PDR患者视功能恢复和新生血管消退,而联合治疗的疗效又略胜于单独抗VEGF治疗,这可能为将来增生性糖尿病性视网膜病变治疗的专家共识制定提供一定参考依据。但仍希望有更多高质量的研究出现以提供更加可靠的证据。

康柏西普联合PRP治疗视网膜中央静脉阻塞继发早期新生血管性青光眼

目的:对比研究玻璃体腔注射康柏西普联合全视网膜激光光凝(PRP)与单纯全视网膜激光光凝对视网膜中央静脉阻塞(CRVO)继发Ⅰ、Ⅱ期新生血管性青光眼治疗效果的临床观察。方法:采取临床病例对照研究方法。将2014-01/2019-03在我院诊断为CRVO继发Ⅰ、Ⅱ期新生血管性青光眼患者60例60眼,随机分为联合治疗组和单纯治疗组。联合治疗组采用康柏西普联合全视网膜激光光凝治疗;单纯治疗组采用单纯全视网膜激光光凝治疗。观察两组患者治疗前、治疗后1wk,1、3、6、9mo的视力、眼压、虹膜新生血管、房角新生血管的情况,进行统计学分析。结果:不同时间点两组房角及虹膜新生血管数量和视力、眼压有差异(F=154.992、92.519、30.696、82.374,均P<0.001),联合治疗组在治疗开始后1wk的各项指标均出现明显好转,并维持至治疗结束。而单纯治疗组在给予治疗后数据改善程度不及联合治疗组(F=50.870、24.265、13.125、11.829,均P<0.001)。结论:玻璃体腔注射康柏西普联合全视网膜激光光凝治疗CRVO继发Ⅰ、Ⅱ期新生血管性青光眼疗效优于单纯全视网膜激光光凝治疗,效果显著并持续维持。

532nm激光PRP联合羟苯磺酸钙对DR患者眼底微循环及黄斑厚度的影响

目的:分析532nm激光全视网膜光凝术(PRP)联合羟苯磺酸钙对糖尿病视网膜病变(DR)患者眼底微循环及黄斑厚度的影响,为DR患者的临床治疗提供试验数据。方法:将我院2017-01/2019-01期间收治的DR患者174例239眼按非随机临床同期对照研究及患者自愿原则分两组,对照组采用532nm激光PRP治疗,观察组在对照组基础上联合羟苯磺酸钙治疗。比较两组患者治疗前、治疗后(PRP术后3mo时)的BCVA(LogMAR)、临床疗效、眼底微循环、黄斑厚度,并统计治疗期间并发症发生率。结果:两组患者治疗后BCVA(LogMAR)较治疗前均有改善,且观察组临床疗效优于对照组(均P<0.001);治疗后两组患者视网膜中央动脉(CRA)、睫状后动脉(PCA)的阻力指数(RI)较治疗前下降(P<0.05),收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)较治疗前上升(P<0.05),但观察组RI低于对照组,EDV、PSV高于对照组(P<0.001);治疗后两组患者黄斑厚度及其他临床指标(血管瘤、出血斑、视野灰度值)较治疗前均下降(P<0.05),且观察组低于对照组(P<0.001);两组并发症发生率(0.8%vs 2.6%)无差异(χ2=0.344,P=0.557)。结论:较单纯532nm激光PRP治疗DR,联合羟苯磺酸钙疗效更佳,对眼底微循环、黄斑厚度等的改善更显著,且安全性佳。

注射不同剂量康柏西普联合PRP及EX-PRESS引流钉植入术治疗NVG的疗效对比

目的:评估玻璃体腔注射三种剂量康柏西普联合全视网膜光凝(PRP)后行EX-PRESS引流钉植入术治疗新生血管性青光眼(NVG)的有效性及安全性。方法:前瞻性研究。收集我院2018-05/2020-09收治的NVG患者37例37眼,均接受玻璃体腔注射康柏西普3~5d后行PRP。术后1wk内接受EX-PRESS青光眼引流钉植入术。采用随机数字表法,将术前玻璃体腔注射三种剂量康柏西普分为低剂量组(13眼)、常规剂量组(12眼)、高剂量组(12眼),分别玻璃体腔注射10mg/mL康柏西普0.03、0.05、0.08mL(含康柏西普0.3、0.5、0.8mg)。观察三组患者玻璃体腔注药后虹膜及房角新生血管(NV)消退情况,比较三组患者术后眼压(IOP)、最佳矫正视力(BCVA)、并发症。结果:所有患者均完成随访。三组患者玻璃体腔注射后3~5d,虹膜及房角NV消退眼数高剂量组明显高于低剂量组(χ^(2)=0.132,P=0.003)、常规剂量组(χ^(2)=0.154,P=0.015)。三组术后1、3、6mo时,BCVA、IOP均较术前有所改善。术后12mo低剂量组、常规剂量组、高剂量组的IOP分别为14.12±2.63、13.37±2.18、12.15±1.43mmHg,高剂量组IOP均低于低剂量组及常规剂量组(均P<0.05)。术后12mo高剂量组BCVA均优于低剂量组及常规剂量组(均P<0.05)。术后12mo并发症发生率三组之间均无差异(P>0.05)。结论:玻璃体腔注射0.8mg高剂量康柏西普联合PRP及EX-PRESS引流钉植入术治疗NVG临床效果尤为显著。