贝伐单抗辅助手术治疗严重增殖性糖尿病视网膜病变

目的：探讨术前应用贝伐单抗辅助23G玻璃体切除术治疗严重增殖性糖尿病视网膜病变的疗效。

方法：回顾性分析本院2014-01/2015-06收治的严重增殖性糖尿病视网膜病变患者90例的病例资料，均为单眼病变。所有患者均行23G玻璃体切除术联合眼内激光光凝，根据术前是否玻璃体腔注射贝伐单抗分为两组，术前未予以贝伐单抗注射者为对照组(40例)，术前注射贝伐单抗者为研究组(50例)。术后均随访6～12mo，比较两组患者手术时间、术后眼压、视力、黄斑厚度变化，并观察术后并发症情况。

结果：两组患者术后整体最佳矫正视力(best corrected visual acuity，BCVA)变化，差异均存在统计学意义(P<0.01)； 但组间术后不同时间点BCVA比较，差异无统计学意义(P>0.05)。两组患者术后眼压变化，差异无统计学意义(P>0.05)。两组患者术后黄斑厚度变化，差异有统计学意义(P<0.05)。术后1d两组患者黄斑厚度均显著下降，黄斑厚度均在术后3mo开始稳定，组间比较差异无统计学意义(P>0.05)。研究组手术时间较对照组短，组间差异有统计学意义(P<0.05)。且研究组医源性视网膜裂孔和牵拉性视网膜脱离发生率均显著较对照组低，组间差异有统计学意义(P<0.05)。

结论：术前玻璃体腔注射贝伐单抗辅助23G玻璃体切除术联合眼内光凝术治疗严重增殖性糖尿病视网膜病变术中时间短，并且可以减少术中和术后并发症。

Bevacizumab-assisted surgery in the treatment of severe proliferative diabetic retinopathy

AIM: To explore the effect of preoperative bevacizumab assisted 23G vitrectomy combined with endolaser photocoagulation in the treatment of severe proliferative diabetic retinopathy.

METHODS: A retrospective analysis of 90 cases with severe proliferative diabetic retinopathy in our hospital from January 2014 to June 2015, which were all monocular lesion, and all patients received 23G vitrectomy combined with endolaser photocoagulation, 40 cases without preoperative injection of bevacizumab were set as the control group, 50 cases with preoperative injection of bevacizumab were set as the study group. All patients were followed up for 6 to 12mo, the operative time, postoperative intraocular pressure, visual acuity, the change of macular thickness were compared between the two groups, and we observed postoperative complications.

RESULTS: There were significant differences in overall BCVA between the two groups(P<0.01). However, there was no significant difference in BCVA between the two groups after operation(P>0.05).There was no significant difference on postoperative IOP in both groups(P> 0.05). There was significant difference between the two groups on macular thickness(P<0.05). The thickness of the macula significantly decreased in both groups at 1d after operation, and the thickness of the macula was stable at 3mo after operation. There was no significant difference between the two groups(P> 0.05). The operation time of the study group was shorter than that of the control group, with significant difference between the two groups(P<0.05). And the incidence of iatrogenic retinal tears and retinal detachment in study group were significantly lower than those in control group(P<0.05).

CONCLUSION: Compared with single vitrectomy, preoperative bevacizumab assisted 23G vitrectomy combined with endolaser photocoagulation in the treatment of severe proliferative diabetic retinopathy has certain effect and short operation time, and can reduce intraoperative and postoperative complications.