25G玻璃体切除联合DEX治疗PDR继发玻璃体积血伴DME

目的：评价25G玻璃体切除(PPV)联合地塞米松玻璃体内植入剂(DEX)治疗增殖性糖尿病视网膜病变(PDR)继发玻璃体积血伴糖尿病性黄斑水肿(DME)的临床效果。

方法：前瞻性临床病例研究。选取2020-07/2022-01天津市眼科医院收治的PDR继发玻璃体积血伴DME的患者40例40眼，所有患者均行玻璃体切除和白内障超声乳化手术，随机分为PPV组(20眼)和PPV+DEX组(20眼)。比较两组患者术前，术后1、3、6mo最佳矫正视力(BCVA)、眼压及黄斑中心凹厚度(CMT)。

结果：所有患者均完成术后6mo随访。术后1、3、6mo PPV+DEX组患者BCVA均优于PPV组(P<0.05)。术后1mo，PPV+DEX组CMT低于PPV组(P<0.05)。随访6mo，PPV组术后出现视网膜新生血管或CMT消退小于5%者8眼行补充抗VEGF治疗，PPV+DEX组仅有1眼(P<0.05)。

结论：玻璃体切除手术联合应用地塞米松植入剂可以产生协同效应，为PDR继发玻璃体积血伴DME的患者提供更优的治疗效果。

25G pars plana vitrectomy combined with Dexamethasone intravitreal implants for the treatment of vitreous hemorrhage and diabetic macular edema secondary to proliferative diabetic retinopathy

AIM: To evaluate the clinical effect of 25G pars plana vitrectomy(PPV)combined with dexamethasone intravitreal implant(DEX)on the treatment of vitreous hemorrhage and diabetic macular edema(DME)secondary to proliferative diabetic retinopathy(PDR).

METHODS: Prospective clinical case study. A total of 40 patients(40 eyes)with vitreous hemorrhage and DME secondary to PDR who treated in Tianjin Eye Hospital from July 2020 to January 2022 were included in the study. All eyes underwent 25G PPV and cataract phacoemulsification. The patients were randomly divided into PPV group(20 eyes)and PPV+DEX group(20 eyes). Best corrected visual acuity(BCVA), intraocular pressure, and central macular thickness(CMT)of the patients before and 1, 3, 6mo after the operation were compared.

RESULTS: All patients were followed up for 6mo. The BCVA of the patients in the PPV+DEX group improved better than that of the PPV group at 1, 3 and 6mo after surgery(P<0.05). CMT of the PPV+DEX group was lower than that of the PPV group at 1mo after operation(P<0.05). Retinal neovascularization or CMT regression with less than 5% was found in 8 eyes in the PPV group, who were supplemented with anti-vascular endothelial growth factor, while it was found in only 1 eye in the PPV+DEX group(P<0.05).

CONCLUSION: PPV combined with DEX could yield synergies, which provide better therapeutic effect for the patients with vitreous hemorrhage and DME secondary to PDR.