雷珠单抗联合白内障超声乳化术治疗白内障合并糖尿病性黄斑水肿的临床研究

目的:探讨雷珠单抗联合白内障超声乳化术治疗白内障合并糖尿病性黄斑水肿的临床价值。方法:按随机数字表法将2017年1月—2019年1月就诊的94例(107眼)白内障合并糖尿病性黄斑水肿患者分为两组,对照组47例(54眼)行白内障超声乳化人工晶状体植入术治疗,观察组47例(53眼)在对照组手术基础上联合雷珠单抗治疗。比较两组最佳矫正视力(BCVA)、眼压、黄斑中心视网膜厚度(CMT)及术后并发症发生情况。结果:术后两组BCVA水平均明显提高,观察组BCVA水平高于对照组,差异有统计学意义(P<0.05);术后两组眼压对比,差异无统计学意义(P>0.05);术后观察组CMT水平低于对照组,差异有统计学意义(P<0.05);两组均未出现严重感染、感染性眼内炎等严重并发症。结论:白内障合并糖尿病性黄斑水肿患者行雷珠单抗联合白内障超声乳化术治疗可有效改善患者最佳矫正视力与黄斑中心视网膜厚度,且不会增加并发症的发生,安全性较高。     

加味五苓散治疗白内障超声乳化术后黄斑水肿的疗效观察

目的:探讨加味五苓散治疗白内障超声乳化术后黄斑水肿的临床疗效.方法:选取2018年1月至2019年7月湖南中医药高等专科学校附属第一医院收治的白内障行超声乳化吸除术后并发黄斑水肿的患者93例,按随机数字表法分为研究组47例(47只眼)和对照组46例(46只眼).对照组患者给予普拉洛芬滴眼液和妥布霉素地塞米松滴眼液点眼治...     

白内障超声乳化术后糖尿病视网膜病的激光光凝治疗

<正>1资料与方法1.1一般资料笔者所在医院2003年至今行白内障超声乳化术的DR患者82例132眼。男34例,女48例;年龄42～85岁,平均59岁。糖尿病史7～16年,增殖型糖尿病视网膜     

激光治疗60例超声乳化术后糖尿病视网膜病变的临床观察

目的探讨激光治疗白内障超声乳化术后糖尿病视网膜病变的疗效。方法对60例（95眼）伴有白内障的糖尿病视网膜病变患者，先行超声乳化摘除术。术后早期进行激光光凝治疗。结果治疗后，患者的视力提高1—5行者有35跟，占36．8％；视力无变化者49眼，占51．6％；视力下降11眼，占11．6％，总有效率88．4％。3个月后行FFA检查，结果显示光凝斑均匀清晰，新生血管萎缩，视网膜水肿消退，出血基本吸收，未见明显的光凝并发症。结论使用激光治疗白内障超声乳化术后糖尿病视网膜病变，具有疗效确切、安全可靠等特点，值得推广应用。     

超声乳化术对糖尿病与非糖尿病白内障患者黄斑中心凹厚度及视网膜厚度的影响

目的 分析超声乳化术对糖尿病与非糖尿病白内障患者黄斑中心凹厚度及视网膜厚度的影响。方法 搜集于2021年1月至2023年1月于本医院进行超声乳化手术治疗的白内障患者作为研究对象,共105例。根据患者是否合并糖尿病疾病作为分组依据将研究对象分为糖尿病组和非糖尿病组,其中糖尿病组共52例,非糖尿病组共53例,两组患者的超声乳化手术均有同一组眼科医师完成,并行人工晶体置入术。比较糖尿病组和非糖尿病组经超声乳化术治疗前与治疗后3个月的黄斑中心凹厚度、视网膜厚度。结果 手术前,糖尿病与非糖尿病白内障患者的黄斑中心凹厚度及黄斑区平均视网膜厚度比较差异无统计学意义（P> 0.05）;手术结束后3个月,两组患者的黄斑中心凹厚度及黄斑区平均视网膜厚度均大于手术治疗前,同组治疗前后对比差异有统计学意义（P <0.05）;糖尿病组患者手术结束后3个月的黄斑中心凹厚度及黄斑区平均视网膜厚度均大于非糖尿病组患者,组间对比差异有统计学意义（P <0.05）。结论 与非糖尿病白内障患者相比,糖尿病白内障患者经过超声乳化术治疗后,其黄斑中心凹厚度及黄斑区平均视网膜厚度均明显增加。     

糖尿病眼底病变患者白内障术后黄斑水肿和视力的分析

目的研究糖尿病眼底病变患者实施白内障手术后期黄斑水肿及视力恢复效果。方法选择2016年10月至2017年10月于我院接受白内障手术的糖尿病患者35例为实验组,另选取同期我院非糖尿病白内障手术患者作为参照组,对上述患者均采用白内障手术,分析患者手术前后视力情况及黄斑中心凹厚度。结果实验组白内障治疗后黄本中心凹度明显高于参照组,二者差异明显(P <0.05)。2组治疗前视力> 0.5患者无显著差异(P> 0.05),经手术实验组治疗后1周及治疗后1个月视力> 0.5的患者明显少于参照组,二者差异明显(P <0.05)。结论与非糖尿病患者相比,糖尿病眼底病变患者白内障术后恢复效果较差,极易发生黄斑水肿,且对视力恢复效果造成一定影响。     

糖尿病性白内障超声乳化术后角膜水肿的治疗及护理

目的:探讨糖尿病性白内障在通过超声乳化术后发生的角膜水肿的相应治疗和护理措施.方法:对259例324眼糖尿病的白内障患者行小切口手术,在超声乳化术后,观察角膜的变化,进行相应的处理及治疗.结果:通过研究得出73眼糖尿病性白内障术后患者出现不同程度的角膜水肿,其中轻度者37眼,水肿4d内自行消退;中度有25眼,水肿7d内消退;重度者11眼,水肿在13～ 16d左右消退.结论:术前完善各种检查,术中嘱患者积极配合手术,术后应对患者及时治疗、观察以及护理,即可有效的防止角膜失代偿引起的水肿,减少术后各种并发症的发生和发展,从而能够得到良好的复明效果.     

糖尿病性白内障超声乳化术后角膜水肿36例临床分析

目的 观察糖尿病性白内障超声乳化术后角膜水肿情况,为临床评估术后角膜受损提供参考.方法 选取行白内障超声乳化术的患者80例(119眼),根据患者是否为糖尿病性白内障将其分为观察组(糖尿病性白内障)36例(54眼)和对照组(非糖尿病性白内障)44例(65眼),行白内障超声乳化术后,对比手术前后的角膜中央厚度、角膜中央内皮细胞计数.结果 两组术前角膜中央厚度差异无统计学意义(P＞ 0.05);观察组术后1天、术后1个月以及术后3个月的角膜中央厚度均显著厚于对照组(A超法:=4.538,6.832,5.038,均P＜0.05;Orbscan Ⅱ法:t=5.392,6.910,4.052,均P＜0.05);术后3个月,观察组角膜中央厚度显著厚于术前(=8.692,P＜0.05),而对照组和术前的对比差异无统计学意义(P＞0.05).两组患者术前和术后1天的角膜中央内皮细胞计数对比,差异无统计学意义(P＞0.05);而术后1个月和术后3个月,观察组的角膜中央内皮细胞计数显著少于对照组(t =5.248,4.892,均P＜0.05).结论 糖尿病性白内障超声乳化术后角膜内皮细胞的损伤更明显,且恢复速度慢,测量术后第1天的角膜中央厚度对评估其角膜内皮细胞损伤情况有重要参考.     

白内障超声乳化术后角膜水肿的防治及护理

目的：探讨白内障超声乳化术后角膜水肿的防治及护理。方法：对5853例6327眼白内障手术病人分析，加强术后角膜观察及护理。结果：共382眼白内障手术后出现角膜水肿。1度水肿217眼，2度水肿106眼。3度水肿47眼，4度水肿12眼，经积极治疗，大部分角膜恢复透明。结论：根据晶体核硬度合理应用超卢能量、娴熟的手术技巧可减少术后角膜水肿，术后做好角膜观察及护理，可防止角膜内皮失代偿的发生。     

糖尿病性白内障患者超声乳化术后角膜情况分析

目的 对糖尿病性白内障超声乳化术后患者角膜内皮情况进行分析。方法 选取行白内障超声乳化吸除联合人工晶体植入术的单纯年龄相关性白内障患者30例35眼(A组)和糖尿病性白内障患者30例39眼(B组),分别于术前1 d、术后1周、术后1月及术后3月对患者进行角膜内皮镜检查,分别收集记录每个患者的中央角膜厚度(CCT)、内皮细胞密度(CD)及六角形细胞百分比(6A%),并进行结果分析。结果 两组患者术前各个指标间差异无统计学意义(P>0.05);术后结果显示CCT与术前相比呈增加趋势,CD及6A%与术前相比呈下降趋势;B组的CCT在术后各个时间点中均高于对照组(P<0.05),CD及6A%低于对照组(P<0.05)。结论糖尿病性白内障患者角膜内皮对白内障超声乳化吸除术的刺激更为敏感,且恢复更慢。因此,做好对糖尿病性白内障患者的术前角膜内皮检查,尽量避免术中超声因素与机械因素的影响,对此类患者至关重要。     

激光联合复方血栓通胶囊治疗糖尿病视网膜病变合并黄斑水肿的疗效观察

目的:分析糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效。方法:选取我院2017年1月—2019年1月收治的200例糖尿病视网膜病变合并黄斑水肿患者为研究对象,随机分为两组。对照组单独行激光治疗,观察组于对照组基础上联合复方血栓通胶囊治疗,对比两组临床疗效、治疗前后IL-6(白介素-6)、VEGF(血管内皮生长因子)、NOS(血清一氧化氮合成酶)水平变化情况。结果:对照组总有效率(68.00%,68/100)较观察组总有效率(98.00%,98/100)更高(P<0.05);与对照组对比,观察组治疗后NOS水平更高,IL-6、VEGF水平更低(P<0.05)。结论:糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效显著,值得推广。     

Emerging drugs for diabetic macular edema

Introduction: Diabetic macular edema (DME) is the most common cause of visual impairment due to diabetic retinopathy. The treatment of DME has recently undergone a paradigm shift. Traditionally, photocoagulation was standard treatment, but pharmacologic therapies are becoming increasingly used for this purpose. All currently available drug therapies for DME are either anti-VEGF agents or corticosteroids.

Areas covered: The pathogenesis of DME involves angiogenesis, inflammation and oxidative stress. The scientific rationale to treat DME through the pharmacologic blockade of VEGF and other pro-angiogenic factors is discussed. The fluocinolone insert is approved for the treatment of DME in several European countries, but not in the US at this time. Some medications that are already approved for other retinal diseases, most prominently aflibercept and the dexamethasone delivery system, have recently obtained approval for DME in the US. Other compounds are being studied in earlier-phase clinical trials.

Expert opinion: Pharmacologic treatment of DME will likely become increasingly used, especially for patients with edema involving the fovea. At this time, the two main classes of medication for treatment of DME are anti-VEGF agents and corticosteroids. As we continue to collect clinical trials data, the precise role of individual agents, and the continuing role for photocoagulation, will become more clear.     

Emerging pharmacotherapies for diabetic macular edema

Diabetic macular edema (DME) is the most frequent cause of severe vision impairment in patients with non-proliferative diabetic retinopathy. Even though patients should achieve optimal glycemic control, normalization of blood pressure and serum lipids, as well as improvement of cardiac and renal status, these measures alone will not prevent every patient from developing visual loss caused by DME. The goal of local treatment for DME is vision improvement, usually achieved after reducing leakage on fluorescein angiography (FA) and retinal thickness on optical coherence tomography (OCT). Laser photocoagulation is still the standard treatment for clinically significant DME. However, laser photocoagulation rarely provides major visual improvement, especially in patients with diffuse DME. Thus, a therapeutic intervention that restores visual acuity impaired by DME more often remains a significant unmet medical need. This review aims to present the most important emerging drug technologies for therapy of DME at present, including corticosteroids, vascular endothelial growth factor inhibitors, protein kinase C inhibitors, small interfering RNA, hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors and non-hormonal anti-inflammatory agents. Recent progress in this field suggests that local management of DME may change rapidly in the near future. Novel emerging drugs should enable better anatomical and functional outcomes for therapy of this sight-threatening disease.     

芪明颗粒联合视网膜激光治疗糖尿病性黄斑水肿的疗效分析

目的 观察芪明颗粒联合激光治疗对糖尿病性黄斑水肿的疗效.方法 将患者随机分为2组,治疗组28例50眼,对照组26例48眼.2组均行光凝治疗,治疗组同时加服芪明颗粒.结果 治疗组和对照组患者治疗1个月、2个月时视力的变化差异无统计学意义(1个月时U=0.2785,P>0.05;2个月时U=0.2869,P>0.05).3个月时2组视力变化差异有统计学意义(U=2.2412,P<0.05).2组患者于治疗后3个月黄斑水肿消退情况,2组比较差异有统计学意义(3个月时U=2.1775,P<0.05).激光治疗3个月后2组患者1~2环(黄斑区)mfERG比较,与治疗前相比,2组患者a波、b波的振幅密度均增加,差异均有统计学意义(P<0.05),治疗后2组之间比较,1环a波的振幅密度治疗组优于对照组,差异有统计学意义(P<0.05),2组治疗前后1~2环(黄斑区)a波、b波的潜伏期与治疗前相比无明显变化(P>0.05).结论 芪明颗粒联合激光治疗可更有效地减轻糖尿病性黄斑水肿,改善患者视力.     

Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery

ABSTRACT

Introduction: Cataracts and diabetes are widespread pathologies that are of growing concern to the global population. In diabetic patients who have had cataract surgery, the worsening of preexisting diabetic macular edema or occurrence of pseudophakic cystoid macular edema are common causes of visual impairment even with the most advanced surgical techniques available today for phacoemulsification.

Areas covered: In this review, the authors assess the available literature to evaluate and compare different drugs, with the aim of establishing the best pharmacological strategies for the prevention and treatment of macular edema in diabetic patients undergoing cataract surgery.

Expert opinion: Guidelines for the optimal management of diabetic macular edema in conjunction with cataract surgery or treatment of pseudophakic cystoid macular edema in diabetic patients are still lacking. To treat these conditions, clinicians need to understand the pharmacokinetics, posology, and efficacy of available drugs: topical non-steroidal anti-inflammatory drugs (NSAIDs), intravitreal anti-vascular endothelial growth factors (VEGFs), and both topical and intravitreal steroids. Diabetic patients undergoing cataract surgery should receive topical NSAIDs to prevent pseudophakic cystoid macular edema. Intravitreal anti-VEGFs and steroids, in association with cataract surgery, are indicated for patients with preexisting diabetic macular edema or those at high risk of macular edema after surgery.     

Acute serous macular detachment and cystoid macular edema after uncomplicated phacoemulsification using standard dose subconjunctival cefuroxime

Acute toxic serous macular detachment after cataract surgery is very rare, and has been described previously with the use of high concentrations of intra-cameral cefuroxime. We report a case of serous macular detachment and cystoid macular edema 1 day after uncomplicated phacoemulsification using standard dose subconjunctival cefuroxime at the end of surgery. Our case demonstrates that subconjunctival cefuroxime may cause retinal toxicity in a similar fashion to intra-cameral cefuroxime, possibly due to entry of the drug into the anterior chamber through the section or trans-scleral absorption. To our knowledge, this is the first report of this complication with subconjunctival administration of cefuroxime.     

玻璃体手术治疗增生性糖尿病视网膜病变39例

目的观察玻璃体手术治疗增生性糖尿病视网膜病变的疗效及并发症。方法回顾性分析39例（61眼）增生性糖尿病视网膜病变患者行玻璃体视网膜手术的临床资料。随访10-24个月,平均随访时间13．5个月。结果术后视力提高51眼（83．61％）,视力不变8眼（13．11％）,视力下降2眼（3．28％）。术前视力光感42眼,指数～0．0213眼,0．03～0．056眼。术后视力无光感1眼,光感2眼,指数～0．025眼,0．03～0．058眼,0．06～0．111眼,0．12～0．318眼,0．3以上16跟。并发症主要为术中出血和医源性视网膜裂孔。结论玻璃体手术治疗增生性糖尿病视网膜病变疗效佳,并发症少。     

羟苯磺酸钙胶囊联合雷珠单抗治疗糖尿病视网膜病变黄斑水肿的临床研究

目的观察羟苯磺酸钙联合雷珠单抗治疗糖尿病视网膜病变黄斑水肿的临床疗效和安全性。方法将76例糖尿病视网膜病变黄斑水肿患者随机分为对照组和试验组,每组38例。对照组给予羟苯磺酸钙每次500 mg,每天3次,口服;试验组在对照组治疗的基础上,给予雷珠单抗每次0. 5 mg,玻璃体腔内注射,每隔4周重复注射1次,共治疗3次。比较2组患者的临床疗效、最佳矫正视力(BCVA)、黄斑中心厚度(CMT)及血清血管内皮生长因子(VEGF)、促血管生成素1(Ang^-1)、促血管生成素2(Ang-2)和药物不良反应发生情况。结果治疗后,对照组总有效率为78. 95%(30例/38例),试验组为94. 74%(36例/38例),差异有统计学意义(P <0. 05)。治疗后,对照组和试验组血清VEGF分别为(125. 62±25. 67)和(92. 34±22. 79)μg·L^-1,血清Ang^-1分别为(10. 62±2. 37)和(13. 89±2. 58)μg·L^-1,血清Ang-2分别为(5. 29±1. 05)和(4. 23±0. 94)μg·L^-1,BCVA分别为0. 61±0. 16和0. 73±0. 15,CMT分别为(265. 41±62. 34)和(203. 17±54. 78)μm,差异均有统计学意义(均P <0. 05)。对照组的药物不良反应发生率为10. 53%(4例/38例),试验组为15. 79%(6例/38例),差异无统计学意义(P> 0. 05)。结论羟苯磺酸钙联合雷珠单抗对糖尿病视网膜病变黄斑水肿的临床疗效确切,有助于改善眼底循环,提高视力。     

Nonbiological pharmacotherapies for the treatment of diabetic macular edema

Introduction: During the past decade, there have been significant advances in the pharmacotherapies for the treatment of diabetic macular edema (DME). Among the presently available treatment options, anti-vascular endothelial growth factors (anti-VEGF) agents are the most favored agents due to their efficacy and safety. The index review focuses on nonbiological therapies that have entered in phase 3 clinical trials for DME.

Areas covered: An extensive review of the literature was performed to identify various nonbiological immunotherapies i.e., drugs other than ‘-mAbs’ (monoclonal antibodies including anti-VEGF agents), ‘-mibs’ (proteasome inhibitors), ‘-NAbs’ (nanoparticle albumin-bound), and ‘-nibs’ (small molecule inhibitor/tyrosine kinase inhibitors), among others. Extended-release low-dose corticosteroid devices have been recently approved for the treatment of DME. Other compounds such as non-steroidal anti-inflammatory drugs, antibody mimetic proteins, nonbiological growth factor inhibitors, and inhibitors of protein kinase C have been described.

Expert opinion: A number of therapies are under development for the pharmacological management of DME. Due to the rising healthcare costs associated with anti-VEGF agents, a number of alternate treatment options have been explored recently. Some of these agents have reached phase 3 in clinical trials and appear to have a promising role in the management of DME. As further research is conducted, the role of each individual agent will become more defined, alone or in combination therapy.