23G玻璃体切割术前玻璃体腔注射雷珠单抗的临床观察

目的：观察增生型糖尿病视网膜病变( proliferative diabetic retinopathy,PDR)患者玻璃体腔注射雷珠单抗( intravitreal injection of ranibizumab,IVR)对23G 玻璃体切割手术疗效的影响。
　　方法：回顾性病例对照研究。临床确诊为PDR需行23 G玻璃体切割手术治疗的患者62例67眼纳入研究。术前7~10 d行IVR 治疗者37眼作为注药玻璃体切割组；未行IVR 治疗者30眼作为单纯玻璃体切割组。两组患眼均由同一医生完成23 G 玻璃体切割手术( pars plana vitrectomy, PPV)。通过手术记录及手术中三方核查表获得术中操作及手术时间,计算并比较分析两组患眼手术中手术时间、电凝、眼内填充物(硅油或惰性气体)使用率以及医源性裂孔发生率。对比分析两组患眼手术后视力提高率。
　　结果：注药玻璃体切割组、单纯玻璃体切割组手术时间分别为91.7±20.8、117.6±18.6min。注药玻璃体切割组手术时间较单纯玻璃体切割组明显缩短,差异有统计学意义(t =-5.314,P<0.05)。电凝使用率：注药玻璃体切割组为11%,单纯玻璃体切割组为47%,两组比较差异有统计学意义(χ2=8.963,P=0.006)；医源性裂孔发生率：注药玻璃体切割组为5%,单纯玻璃体切割组为33%,两组比较差异有统计学意义(χ2=8.789, P=0.004)；硅油或气体填充率：注药玻璃体切割组为27%,单纯玻璃体切割组为53%,两组比较差异有统计学意义(χ2=4.828, P=0.043)；术后视力提高率：注药玻璃体切割组为76%,单纯玻璃体切割组为47%,两组比较差异有统计学意义(χ2=5.960,P=0.022)。所有患眼均未发生脉络膜脱离、视网膜脱离、眼内炎等严重术后并发症。
　　结论：PDR患眼23 G玻璃体切割手术前IVR 可缩短手术时间、减少术中电凝、眼内填充物的使用率及医源性裂孔发生率,并在一定程度上更好地提高患眼视力。

Effect of Ranibizumab intravitreal injection before 23G-vitrectomy surgery in the treatment of patients with proliferative diabetic retinopathy

AIM: To analyze the effect of preoperative intravitreal injection of Ranibizumab ( lVR ) in patients undergoing pars plana vitrectomy ( PPV ) for proliferative diabetic retinopathy ( PDR) .
●METHODS:ln this retrospective research, 62 patients (67 eyes ) with PDR in the First Affiliated Hospital of Xinjiang Medical University from Jun. 2014 to Jun. 2015 were recruited. They were assigned to an experimental group ( n=37 eyes ) and a control group ( n=30 eyes ) . The patients in experimental group were given 1 injection of lVR ( Lucentis 1. 0mg/0. 1mL ) 1wk before surgery, whereas those in control group went down to surgery directly. The average operation time, iatrogenic breaks, the use of tamponade, electric coagulation, and vision increase rate were comparatively analyzed between two groups.
●RESULTS:The average operation time was (91. 7±20. 8) min in the experimental group vs (117. 6±18. 6)min in the PPV group(t = -5. 314,P<0. 05). The rate of electric coagulation (11%) vs (47%), (χ2 =8. 963, P=0. 006);iatrogenic breaks (5%) vs (33%), (χ2=8. 789, P=0. 004) and silicone oil or inert gas tamponade ( 27. 0%) vs (53. 3%), (χ2 = 4. 828, P = 0. 043 ). The rate of visual improvement (75. 7%) vs (46. 7%), (χ2 = 5. 960, P =0. 022 ) . There was no severe complication associated with surgery, such as choroidal detachment, retinal detachment and endophthalmitis.
●CONCLUSION:lVR before microincision vitrectomy can effectively shorten the operation time, reduce the use of electric coagulation and intraocular tamponade, and improve the rate of visual improvement for PDR patients.