康柏西普治疗增殖性糖尿病视网膜病变患者玻璃体切除术后迟发性玻璃体出血

目的：观察玻璃体腔注射康柏西普治疗增殖性糖尿病视网膜病变(PDR)患者玻璃体切除术后迟发性玻璃体出血(POVCH)的效果。

方法：回顾性分析。纳入PDR患者玻璃体术后发生POVCH患者56例57眼，其中康柏西普组28眼行玻璃体腔内注射0.05mL康柏西普，对照组29眼不进行玻璃体腔内注射康柏西普，观察或使用口服药物治疗。记录患者玻璃体切除前后、玻璃体腔注药前后、POVCH后1mo时及随访结束时最佳矫正视力(BCVA)、玻璃体积血分级、眼压、眼底情况及再次手术(玻璃体腔灌术)情况。并观察POVCH发生时患者血糖、血压及心理等全身情况。

结果：POVCH后1mo时，康柏西普组的BCVA优于对照组(1.26±0.13 vs 1.76±0.20； P=0.04)，POVCH发生时及随访结束时两组BCVA无统计学差异(P=0.08，0.24)。玻璃体积血混浊改善程度：康柏西普组显效13眼，有效9眼，无效6眼； 对照组显效11眼，有效3眼，无效15眼，差异有统计学意义(P=0.03)。康柏西普组POVCH眼再次手术率低于对照组(21% vs 51%， P=0.045)。康柏西普组平均玻璃体注药次数为2.24±1.16(1～5)次。随访12～24(平均16.47±3.34)mo。POVCH发生的28眼中，发现眼底纤维血管膜11眼(19%)，视网膜新生血管11眼(19%)，新生血管性青光眼10眼(18%)，虹膜新生血管4眼(7%)。POVCH出血吸收后补充视网膜光凝44眼(77%)。POVCH发生时患者血糖和(或)糖化血红蛋白高、血压异常者43例(75%)，情绪激动或劳累者6例(11%)。

结论：玻璃体腔内注射康柏西普可促进PDR患者POVCH积血吸收，提高视力，降低再次玻璃体切除手术的几率，同时也应注意严格控制PDR患者的血糖、血压、精神心理等全身因素。

Conbercept for late postoperative vitreous cavity haemorrhage in patients with proliferative diabetic retinopathy

AIM: To observe the efficacy of intravitreal injection of conbercept in the treatment of late postoperative vitreous cavity haemorrhage(POVCH)in patients with proliferative diabetic retinopathy(PDR).

METHODS: A total of 56 patients(57 eyes)with late POVCH after vitrectomy in patients with PDR were retrospectively analyzed. Among them, 28 eyes that received intravitreal injection of 0.05 mL conbercept were selected as the conbercept group, whereas 29 eyes that did not receive intravitreal injection of conbercept were selected as the control group. Best corrected visual acuity(BCVA), the degree of vitreous haemorrhage(VH), intraocular pressure and ocular fundus were recorded before and after vitrectomy and injection, at 1mo after late POVCH and at the end of follow-up, respectively. Moreover, the number of eyes that received the secondary surgery(vitreous lavage)was compared and the patients'' general conditions such as blood glucose, blood pressure and mental health were observed.

RESULTS: BCVA was better in the conbercept group than in the control group(1.26±0.13 vs.1.76±0.20; P=0.04)at 1mo after late POVCH.There was no difference in BCVA at POVCH onset and at the end of follow-up between the two groups(P=0.08, 0.24). In terms of VH opacity,there was significant improvement in 13 eyes, moderate improvement in 9 eyes and no improvement in 6 eyes in the conbercept group. However,in the control group, there was significant improvement in 11 eyes, moderate improvement in 3 eyes and no improvement in 15 eyes(P=0.03). Eyes in the conbercept group showed less possibility of reoperation than those in the control group(21% vs. 51%,P=0.045). The mean times of injections in the conbercept group was 2.24±1.16(range: 1-5). The follow-up period ranged from 12 to 24mo,with an average of 16.47±3.34mo. Among the 28 eyes with POVCH,11(19%)eyes had the fundus fibrous vascular membrane and 11(19%)eyes had retinal neovessels.Neovascular glaucoma(NVG)and iris neovascularization were observed in 10(18%)and 4(7%)eyes, respectively. After the amelioration of haemorrhage of POVCH in 57 eyes, 44(77%)eyes were supplemented with retinal photocoagulation. At POVCH onset, 43(75%)patients exhibited abnormal blood glucose(glycosylated hemoglobin)and(or)blood pressure,and 6(11%)patients were reported to felt tired or anger.

CONCLUSION: Intravitreal injection of conbercept for late POVCH in patients with PDR can promote the amelioration of haemorrhage, improve visual acuity, and reduce the need for reoperation. Moreover, strict control of systemic factors such as blood pressure, blood glucose and psychological situation is crucial in patients with PDR for late POVCH.