玻璃体内注射雷珠单抗联合玻璃体切割术治疗严重增生型糖尿病视网膜病变

目的　观察玻璃体内注射雷珠单抗联合玻璃体切割术治疗严重增生型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉ-ｎｏｐａｔｈｙ，ＰＤＲ）的临床效果。方法　将临床确诊为严重ＰＤＲ的患者５２例７２眼纳入本研究。依据术前是否行玻璃体内注射雷珠单抗将患者分为治疗组和对照组:治疗组３０例４２眼、对照组２２例３０眼。治疗组术前３ｄ玻璃体内注射１０ｇ·Ｌ－１雷珠单抗０．０５ｍＬ（０．５ｍｇ），然后行玻璃体切割术，对照组直接行玻璃体切割术。术后随访３～１２（６．５±１．３）个月。对比分析两组患者视力、眼压、黄斑中心凹视网膜厚度和术后并发症的发生情况。结果　治疗组、对照组手术后视力分别为０．０９０±０．０６８、０．０６０±０．０２９，均较术前提高，２组治疗前、治疗后视力比较差异均有统计学意义（ｔ＝－５．００５、－３．２３７，均为Ｐ＜０．０５）。两组术后视力比较，差异有统计学意义（ｔ＝２．０３４，Ｐ＜０．０５）。治疗组、对照组术后黄斑中心凹视网膜厚度分别为（３１３．８±２７．３）μｍ、（３２５．６±１４．５）μｍ，差异有统计学意义（ｔ＝－１．５１，Ｐ＜０．０５）。术后２周、１个月、３个月，治疗组玻璃体积血发生率分别为１２％、２％、２％，对照组发生率分别为２７％、２０％、３％；两组术后各时间点发生率比较，术后２周及１个月之间差异均有统计学意义（χ２＝３．４２、３．２１，均为Ｐ＜０．０５），术后３个月差异无统计学意义（χ２＝１．０２，Ｐ＞０．０５）。结论　玻璃体切割术联合玻璃体内注射雷珠单抗治疗严重ＰＤＲ能提高患者视力，降低术后玻璃体积血发生率和黄斑中心凹视网膜厚度。

Ranibizumab injection and vitrectomy for severe proliferative diabetic retinopathy

Objective To observe the clinical effects of vitrectomy assisted with intravitreal injection of ranibizumab for severe proliferative diabetic retinopathy( PDR) . Methods A total of 52 patients( 72 eyes) with severe PDR were enrolled.and divided into treatment group ( 30 patients ,42 eyes) and control group ( 22 patients , 30 eyes ) . The patients in treatment group received an intravitreal injection of 0. 05 mL rarubizumab solution( 10 g . L ’l ) firstly, and 3 0r 4 days later they received vitrectomy. The patients in control group only received vitrectomy. The follow-up time was 3 months t0 12 months with an average of ( 6. 5 + 1. 3 ) months. The visual acuity, intraocular pressure . central retinal thickness ( CRT) and incidence of postoperative complications were observed. Results The mean postoperative logMAR visual acuity in treatment group and control group were 0. 09 + 0. 068 and 0. 06 + 0. 029 .which were all higher than pre-operation , the difference was statistically significant ( t = - 5. 005 , - 3. 237 , all P < 0. 05 ). The mean post-operative logMAR visual acuity in treatment group was higher than that of control group , the difference was statistically significant ( t = 2. 034 .P < 0. 05 ) . The average postoperative CRT in treatment group and control group were ( 313. 8 + 27. 3) ym and ( 325 . 6 + 14. 5 ) ym , the difference was statistically sigruficant ( t = - 1. 51 .P < 0. 05 ) . The incidences of postoperative vitreous hemorrhage in treatment group and control group were 12% and 27% at 2 weeks after surgery,2% and 20% at I month after surgery,2% and 3% at 3 months after surgery , respectively , the differences was statistically significant for 2 weeks (X2 = 3. 42 ,P < 0. 05 ) and I month( t = 3. 21 ,P < 0. 05 ) .but there was no statistical difference for 3 months (X2 = 1. 02 ,P > 0. 05 ) . Conclusion Vitrectomy assisted with intravitreal injection of ranibizumab for severe PDR can effectively improve visual acuity , prevent postoperative vitreous hemorrhage and reduce CRT.