药物辅助下玻璃体切除术治疗增生性糖尿病视网膜病变

目的:探讨曲安奈德联合Bevacizumab(Avastin)辅助玻璃体切除术治疗严重糖尿病视网膜病变的临床应用价值。方法:回顾性分析药物辅助下玻璃体切除治疗的严重增生性糖尿病视网膜病变13例15眼,15眼均于术前3~14d行Bevacizumab(Avastin)1.25mg/0.05mL玻璃体腔注射,常规玻璃体切除术中使用曲安奈德辅助切除残留的玻璃体皮质、视网膜增殖膜,其中9例合并牵拉性视网膜脱离及黄斑水肿者硅油填充并留置4mg/0.1mL曲安奈德,4眼未使用硅油填充眼因合并黄斑水肿大量硬性渗出予曲安奈德留置。2眼单纯玻璃体积血者未注射曲安奈德。结果:除1例玻璃体腔注射Avastin 3d后术中出血较多特别是在剥离纤维新生血管膜过程中,其余病例术中出血很少,并能迅速自凝。联合曲安奈德辅助可清晰地辨别残留皮质、视网膜前膜甚至内界膜,黄斑水肿术后明显减轻,所有病例术后炎症反应轻,眼压控制良好,硅油眼中留置曲安奈德无明显并发症。结论:严重的增生性糖尿病视网膜病变玻璃体切除术前7~14d玻璃体腔注射Bevacizumab(Avastin),明显减少术中出血,术中使用曲安奈德辅助可视性良好。术毕留置4mg曲安奈德可有效减轻黄斑水肿及术后反应。

Pars plana vitrectomy assisted by Triamcinolone acetonide and Bevacizumab (Avastin) for proliferative diabetic retinopathy

AIM:To evaluate the efficacy of vitrectomy assisted by Triamcinolone acetonide(TA)with preoperative intravitreal injection of Bevacizumab(Avastin)for severe proliferative diabetic retinopathy.METHODS:Thirteen cases(15 eyes)with severe proliferative diabetic retinopathy treated by vitrectomy assisted by TA with preoperative intravitreal injection of Bevacizumab(Avastin)were analyzed retrospectively.3-14 days before vitrectomy,intravitreal injection of Beva-cizumab(Avastin)1.25mg/0.05mL was performed on all 15 eyes.TA was injected into vitreous cavity for easy visualization of residual vitreous cortex and pre-retinal membrane during the process of vitrectomy.Nine cases with traction retinal detachment and severe macular edema were tamponed with silicon oil,meanwhile,4mg/0.1mL of TA was injected into vitreous cavity.Four eyes with macular edema and hard exudate were injected with TA and no tamponade was used.As for the 2 cases with simple vitreous hemorrhage,TA was not used.RESULTS:Obvious bleeding occurred during vitrectomy in the 1 eye that had undergone intravitreal injection of Avastin 3 days ago,especially in the process of peeling the fibreneovascular membrane.Other 14 eyes had little hemorrhage during vitrectomy with assistance of TA,which making vitreous cortex,epiretina membrane and even inner limiting membrane easy visualized.Macular edema decreased after vitrectomy and TA injection.No more severe inflammatory reaction occurred after vitrectomy.The intraocular pressure was under controlled.And there were no side effect of TA in oil eyes.CONCLUSION:Intravitreal injection of Bevacizumab(Avastin)7-14 days before vitrectomy for severe proliferative diabetic retinopathy can reduce the risks of hemorrhage and TA assistance makes vitreous cortex and proliferative membrane visible during operation.Even for silicone oil eye,intravitreal injection of TA 4mg after vitretomy could attenuate macular edema and inflammatory reaction.