摘要
目的通过观察Bevacizumab联合玻璃体切除、曲安奈德治疗增殖性糖尿病视网膜病变（PDR）的视功能恢复及并发症发生情况，回顾性对比分析三联疗法治疗PDR的临床效果和优势。方法PDR患者共98例（98只眼），实验组PDR52例（52只眼），对照组PDR46例（46只眼），全身检查无手术禁忌证，两组均采用标准三通道玻璃体切除术、剥膜、眼内光凝。实验组均在患者知情情况下术前玻璃体腔注射贝伐单抗Avastin1．25mg，第7天行玻璃体切除术，术毕关闭穿刺口前注入曲安奈德2mg。对照组仅在术毕关闭穿刺口前玻璃体腔注入曲安奈德2mg。对比观察两组手术操作时间，术后眼压（IOP），黄斑区厚度及最佳矫正视力。结果在行玻璃体切除、剥膜过程中，实验组剥膜较容易，m血明显减少，对照组剥膜相对较困难，耗时，两组手术时间相比差异有统计学意义（t=28．50，P=0．000）。术后1周、1、3、6个月两组眼压比较差异无统计学意（t=0．664，0．852，0．742，0．110，P=0．515，0．406，0．468，0．914）。术后2周两组相比黄斑区厚度差异有统计学意义（t=5．665，P=0．000）。术后1、3、6月各时间点黄斑区厚度实验组与对照组相比差异无统计学意义（t=0．590，0．984，1．292，P=0．563，0．388，0．213）。术后末次随访视力与术前相比均有不同程度的提高，实验组≤0．0212例，≤0．0511例，≤0．316例，〉0．313例；对照组≤0．0211例；≤0．0512例，≤0．314例，〉0．39例。结论术前玻璃体腔注射Bevacizumab有助于易化手术操作，容易薄膜，减少术中出血，联合曲安奈德玻璃体腔注射有效减轻术后玻璃体腔及前房反应，减轻黄斑水肿，有利于视功能的恢复。
Objective To observe the visual function and the condition of complication hap- pened after bevacizumab combined with vitrectomy and triamcinolone acetonide treat proliferative dia- betic retinopathy （PDR） and to analyze the clinical effect and advantage of three methods together retrospectively. Methods Ninety-eight eyes of PDR patients were divided into two groups, the exper- iment group 52 eyes, the control group 46 eyes, no surgical contraindication by general physical checkup. All two groups accepted standard plan par vitrectomy, stripping of membrane and intraocu- lar photocoagulation. Experiment group received intravitreal administration of bevacizumab （Avastin 1.25 mg） before surgery after accepting the patients＇ content, operating vitrectomy in the seventh day, intravitreal administrated triamcinolone （2 mg） at the end of diabetic vitrectomy, semireclining position 6-8 hours postoperative. The control group only intravitreal administrated triamcinolone （2 rag） at the end of diabetic vitrectomy. Main outcome measures were operation time, intraocular pres-sure （lOP）, macular thickness and best-corrected visual acuity （BCVA）. Results In the course of op- eration and strip membrane, the membranes stripped easily and hemorrhage reduced obviously intraop- erative in the experiment group, the control group strip difficulty and time- consuming, the operation time were statistical significance between two groups （t =28.50, P =0.000）. The IOP were not statisti- cal significance in the first week, the first, the third and the sixth month after operation （t =0.664, 0.852, 0.742, 0.110, P =0.515, 0.406, 0.468, 0.914）. The macular thickness were statistical signifi- cance in the second week after operation （t =5.665, P =0.000）, but were not statistical significance in the first, the third and the sixth month after operation （t =0.590, 0.984, 1.292, P =0.563, 0.388, 0.213）. Visual acuity elevate to some extent contrast to preoperative, the experiment group were 12 eyes ≤0.02, 11 eyes ≤0.05, 16 eyes ≤0.3, 13 eyes 〉0.3; the control group were 11 eyes ≤0.02, 12 eyes ≤〈0.05,14 eyes ≤0.3, 9 eyes 〉0.3. Conclusions Intravitreal administrated bevacizumab pri- or to vitrectomy facilitates vitrectomy procedures, strip membrane easily, reduces hemorrhage intraop- erative and rehaemorrhagia postoperative, combined with intravitreal administrated triamcinolone ace- tonide relieve the reaction of anterior chamber and vitroues postoperative, and relieve macular ede- ma, thus improving the visual function.
出处
《中国实用眼科杂志》
CSCD
北大核心
2012年第12期1477-1480,共4页
Chinese Journal of Practical Ophthalmology
