玻璃体腔内注射雷珠单抗联合激光治疗糖尿病性黄斑水肿的疗效

目的：探讨玻璃体腔内注射雷珠单抗联合激光治疗糖尿病性黄斑水肿(diabetic macular edema，DME)的临床疗效。

方法：回顾性分析2014-06/2016-06于我院眼科治疗的60例60眼DME患者，按照治疗方式不同分为两组，对照组患者采用激光治疗，观察组患者在此基础上联合玻璃体腔内注射雷珠单抗治疗。比较两组患者治疗前和治疗1wk，1、3、6mo后的最佳矫正视力； 采用非接触式眼压计测量治疗前后眼压； 采用光学相干断层扫描(optical coherence tomography，OCT)测量治疗前后黄斑中心凹厚度(central macular thickness，CMT)； 记录两组患者术后并发症发生情况。

结果：两组患者治疗后视力均显著提高； 组间比较：观察组治疗1、3mo后视力均显著高于对照组，差异有统计学意义(P<0.05)； 治疗1wk，6mo后两组间视力差异无统计学意义(P>0.05)。两组患者治疗后1wk眼压有升高现象，差异有统计学意义(P<0.05)； 两组患者治疗前与治疗1、3、6mo后眼压差异无统计学意义(P>0.05)。两组患者治疗后CMT均显著降低； 观察组治疗1、3mo后CMT显著低于对照组，差异有统计学意义(P<0.05)； 治疗前与治疗1wk，6mo后两组CMT差异无统计学意义(P>0.05)。观察组6mo内复发5例5眼，复发率17%，对照组复发10例10眼，复发率33%，差异有统计学意义(P<0.05)； 术后2d观察组2例2眼出现高眼压，对照组3例3眼出现高眼压，经卡替洛尔滴眼液治疗后恢复正常。

结论：玻璃体腔内注射雷珠单抗联合激光治疗相较于单独使用激光治疗，短期内能减轻黄斑水肿，视力恢复更快，能够提高治疗的安全性。

Intravitreal injection of Ranibizumab combined with laser for diabetic macular edema

AIM: To investigate the therapeutic effect of intravitreal injection of Ranibizumab combined with laser for diabetic macular edema(DME).

METHODS: Totally 60 cases(60 eyes)of DME patients treated in ophthalmology department of our hospital from June 2014 to June 2016 were selected and divided into the observation group and the control group. The control group were treated with laser therapy, and the observation group received intravitreal injection of ranibizumab on the basis of the treatment of the control group. Comparison between two groups on the best corrected visual acuity before operation and at 1wk, 1, 3, 6mo after operation was taken. The non-contact tonometer was used to measure intraocular pressure before and after treatment. The optical coherence tomography(OCT)was conducted to assess preoperative and postoperative central macular thickness(CMT).The postoperative complications of two groups were recorded subsequently.

RESULTS: The two groups'' postoperative visual acuity was significantly improved, data of the observation group at 1, 3mo after operation was sharply higher than that of the control group, there was statistical significance(P<0.05), and data at 1wk, 6mo after operation had no evident difference(P>0.05). After 1wk of treatment, the two groups'' intraocular pressure increased, with statistical significance(P<0.05); there was no significant difference between the two groups on intraocular pressure before treatment and at 1, 3, 6mo after treatment(P>0.05). The postoperative CMT of two groups significantly decreased, data of the observation group at 1, 3mo after treatment was evidently lower than that of the control group, there was statistical significance(P<0.05), and data before treatment, at 1wk, 6mo after treatment showed no significant difference(P>0.05). In the observation group, 5 cases(5 eyes)recurred within 6mo, the recurrence rate was 17%. In the control group, 10 cases(10 eyes)relapsed, the recurrence rate was 33%, the difference was statistically significant(P<0.05). At postoperatively 2d, 2 cases(2 eyes)of the observation group and 3 cases(3 eyes)of the control group had high intraocular pressure, and then returned to normal by given the carteolol eye drops.

CONCLUSION: Compared with laser therapy alone, intravitreal injection of ranibizumab combined with laser therapy has a significant and safe short-term treatment effective for DME patients with a fast visual acuity recovery.