雷珠单抗联合激光治疗糖尿病视网膜病变的疗效

目的：探讨雷珠单抗联合激光治疗增生型糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)的临床疗效。

方法：本研究观察对象为2014-10/2016-10我院眼科接诊的80例101眼PDR患者，按照治疗方式不同分为观察组与对照组。对照组40例50眼只采用全视网膜激光光凝(panretinal photocoagulation，PRP)治疗，观察组40例51眼在此基础上术前使用雷珠单抗治疗。比较术前、术后1、3、6mo最佳矫正视力(best corrected visual acuity，BCVA)，光学相干断层成像技术(optical coherence tomography，OCT)检查各时期黄斑中心凹厚度(central macular thickness，CMT)以及各时间视网膜新生血管面积，并比较两组患眼使用激光能量、光斑数以及能量密度，记录不良反应发生情况。

结果：两组患者术后BCVA均显著改善，且观察组术后1、3、6mo均显著高于对照组，差异有统计学意义(P<0.05)； 两组患者治疗后CMT、新生血管面积较治疗前显著降低，且观察组术后1、3、6mo均显著低于对照组，差异均具有统计学意义(P<0.05)； 观察组使用激光能量、光斑数以及能量密度均显著低于对照组，差异具有统计学意义(P<0.05)； 观察组2例2眼，对照组1例1眼出现超过28mmHg眼压，卡替洛尔降压治疗3d后恢复正常，两组均未出现青光眼、视网膜脱离，眼内炎等其他并发症。

结论：雷珠单抗联合激光治疗PDR能显著改善BCVA，降低CMT，消除新生血管，所需激光能量更低，安全有效。

Curative effect of Ranibizumab combined with laser photocoagulation for proliferative diabetic retinopathy

AIM:To investigate the clinical efficacy of Ranibizumab combined with laser photocoagulation in the treatment of proliferative diabetic retinopathy(PDR).

METHODS: Totally 80 patients(101 eyes)with PDR admitted to our hospital from October 2014 and October 2016 were selected and divided into the observation group and the control group, with 50 eyes and 51 eyes respectively. The patients in the control group(50 eyes)were treated with panretinal photocoagulation(PRP), and the patients in observation group(51 eyes)were treated with ranibizumab on the basis of PRP treatment. Best corrected visual acuity(BCVA)was compared before and after surgery 1, 3, and 6mo. Optical coherence tomography(OCT)was used to examine the central macular thickness(CMT)and the area of neovascularization at each timepoints. Then the laser spot number, laser energy and energy density were compared between the two groups and the adverse reactions were recorded.

RESULTS: Postoperative BCVA of the two groups significantly increased, and the BCVA of observation group were significantly higher than that of the control group after surgery 1, 3, 6mo, the difference was statistically significant(P<0.05). After treatment, the CMT and neovascularization area of the two groups significantly decreased, and those of the observation group were significantly lower than those of the control group after surgery 1, 3, 6mo, the difference was statistically significant(P<0.05). The laser spot number, laser energy and energy density of the observation group were significantly lower than those of the control group, the difference was statistically significant(P<0.05). There were 2 cases(2 eyes)in the observation group and 1 cases(1 eye)in the control group, whose intraocular pressure exceeded 28mmHg, while relieved rapidly after the treatment, and no obvious complications occurred in two groups.

CONCLUSION: Ranibizumab combined with laser in the treatment of PDR is an effective and safe way to improve BCVA, reduce CMT, and eliminate new blood vessels with less required laser energy.