玻璃体注药联合微创玻璃体切除治疗增殖性糖尿病视网膜病变的临床应用研究

目的：研究玻璃体腔注射抗新生血管生成药物联合23G玻璃体切除手术治疗严重增殖性糖尿病视网膜病变的临床疗效及并发症情况。方法采用回顾性非随机临床病例研究，共收集2014年5月—2016年5月严重增殖性糖尿病视网膜病变患者45例(45只眼)纳入研究，分析手术前后患者术眼的舒适度、局部水肿等主观自觉症状及最佳矫正视力、眼压、视网膜复位情况等客观指标，以及手术后并发症的发生情况。结果术后1周有30例(66.7%)患者的视力比术前提高，视力平均提高0.77±1.11。术后1个月有24例(88.9%)患者的视力比术前提高，视力平均提高1.29±0.97。术后发生再次玻璃体积血2例，发生孔源性视网膜脱离及高眼压各1例。结论玻璃体注射抗新生血管生成药物联合23G玻璃体切除手术安全、有效，能够改善多数严重增殖性糖尿病视网膜病变患者的视力预后。

A Study on Intra-vitreous Injection Combined with Micro-invasive Vitrectomy in Treatment of Patients with Pro-liferating Diabetic Retinopathy

Objective To study clinical effect and complications of intra-vitreal injection with anti-vascular en-dothelial growth factor (anti-VEGF) drugs combined with 23G micro-invasive vitrectomy (MIVR) in treatment of severe proliferating diabetic retinopathy (PDR). Methods A total of 45 patients with severe PDR (45 eyes) during May 2014 and May 2016 were involved in a retrospectively nonrandomized clinical case study. Subjective feelings such as comfort and local edema of postoperative eyes and objective indexes such as best corrected visual acuity (BCVA), intraocular pressure, retinal relocation before and after surgery and postoperative complications were observed. Results Compared with those before surgery, visual acuity was improved in 30 patients (66. 7%) 1 week after surgery, and the average im-provement value was 0. 77 ± 1. 11;visual acuity was improved in 24 patients (88. 9%) 1 month after surgery, and the average improvement value was 1. 29 ± 0. 97. Vitreous rehemorrhage was found in postoperative 2 patients, and 1 patient with rhegmatogenous retinal detachment and 1 patient with ocular hypertension were found after surgery. Conclusion In-tra-vitreal injection with anti-VEGF drugs combined with 23G MIVR in treatment of severe PDR is safe and effective, and it can improve visual prognosis of most patients.