摘要
目的在联合术前眼内注射雷珠单抗及术中眼内全视网膜光凝(PRP)基础上,比较20G与23G玻璃体切除术治疗增生型糖尿病视网膜病变(PDR)的手术效果。方法 PDR患者88例(98只眼),随机分为20G组40例(48只眼)和23G组44例(50只眼)。玻璃体切除术前1周行眼内注射雷珠单抗,术中行全视网膜光凝,术后随访3个月。以手术时间,术中出血情况、术后最佳矫正视力(BCVA)、眼压、新生血管消退情况、患者满意度为指标,比较两组差异。结果 20G组与23G组的平均手术时间分别为(85.00±25.00)min,(60.00±19.00)min,23G组较20G组明显缩短(P<0.05)。两组术中增生膜表面再出血的情况相当,均各有2只眼。20G组术前、术后1周、1个月、3个月的BCVA(Log Mar视力)分别为1.4±0.02,0.68±0.04,0.54±0.04,0.54±0.03;23G组的BCVA分别为1.6±0.04,0.61±0.01,0.54±0.02,0.58±0.02。两组术后BCVA均较术前提高(P<0.05),但组间差异无统计学意义(P>0.05)。20G组与23G组术后1周、1个月、3个月的眼压分别为(12.8±1.8)mmHg和(12.4±1.2)mmHg;(15.9±2.2)mmHg和(16.5±1.0)mmHg;(16.9±2.6)mmHg和(16.6±2.1)mmHg(1 mmHg=0.133 kPa),差异均无统计学意义(P>0.05)。两组术后1个月荧光素眼底血管造影(FFA)检查,新生血管未完全消退者20G组有2只眼,23G组有3只眼。23G组术中及术后满意度好于20G组(P<0.05)。结论在联合术前眼内注射雷珠单抗及术中PRP基础上,20G与23G两种玻璃体手术治疗PDR均有较好的效果。与20G比较,23G玻璃体手术的操作时间更短,患者术中、术后的不适感更为轻微,满意度更好。
OBJECTIVE To explore the clinical efficacy of 20 G and 23 G vitrectomy on proliferative diabetic retinopathy（PDR） in addition to intravitreal injection with Lucentis before operation and panretinal photocoagulation（PRP） during the procedure.METHODS The clinical data of 88 patients（98 eyes） diagnosed as proliferative diabetic retinopathy who underwent vitrectomy between November 2014 and August 2015 in ophthalmology department of our hospital were analyzed retrospectively.Eighty eight cases were randomly divided into 2 groups as 40 cases（48 eyes） in 20 G group and 44 cases（50 eyes） in 23 G group.All cases were given intravitreal injection of Lucentis 1 week before operation and panretinal photocoagulation during the operation.Patients were followed up for three months after the procedure for indexes including duration of operation,rebleeding in operation,intraocular pressure（IOP）,improvement of postoperative neovascular,best corrected visual acuity（BCVA） and patient satisfaction.Re-sults between two groups were compared.RESULTS The operation duration of 20 G group was 85.00±25.00 min while that of 23 G group was 60.00±19.00 min which meant difference between two groups was of statistical significance（P〈0.05）.Two cases of retinal vessel rebleeding or retinal proliferative membrane rebleeding happened respec-tively in both groups.By comparison,there was no significant difference in the rebleeding rate（P〉0.05）.BCVA（Log Mar） in 20 G and 23 G group were 0.68±0.04 and 0.61±0.01 respectively.The results were not statistically different（P〉0.05）.However,compared with counterparts before operation,results of both group were markedly improved（P〈0.05）.Average intraocular pressure（IOP） of two groups 1 week,1 month,3 months after treatment were 12.8±1.8 mmHg and 12.4±1.2 mmHg,15.9±2.2 mmHg and 16.5±1.0mmHg,16.9±2.6mmHg and 16.6±2.1mmHg respectively.There was no significant difference in postoperative average IOP between two groups（P〉0.05）.Patients of both groups were examined by fluorescence fundus angiography（FFA）1 month after the operation.It showed that neovascular in 2 eyes of 20G group and 3 eyes of 23Gg group were not eliminated.The results had no statistical difference between two groups（P〈0.05）.In addition,patients of 23G group were more satisfied during the procedure and after it than these in 20G group.CONCLUSIONS On basis of intravitreal injection with Lucentis（IVR）before operation and panretinal photocoagulation（PRP）,both 20G and 23G vitrectomy received favorable effects.However,the latter was of less procedure duration and discomfort during and after the surgery thus it yield more satisfied response of patients.
出处
《中国中医眼科杂志》
2017年第4期250-253,共4页
China Journal of Chinese Ophthalmology
