手术后玻璃体内注射受孕术治疗增殖性糖尿病视网膜病变合并玻璃体出血

Q4 Medicine

中华眼底病杂志 Pub Date : 2020-02-25 DOI:10.3760/CMA.J.ISSN.1005-1015.2020.02.004

Jinping Zhang, X. Ren, C. Zheng, D. Wen, Xiaorong Li

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There was significant difference of age between two groups (t=-24.697, P=0.030), but no significant difference of sex (χ2=0.330, P=0.564), duration of diabetes (t=-1.144, P=0.258), logMAR BCVA (t=-0.148, P=0.883), lens state (χ2=0.397, P=0.529), panretinal laser photocoagulation (χ2=1.333, P=0.248). The postoperative injection group was treated with intravitreous injection of 0.05 ml conbercept (10 mg/ml) immediately after 27G minimally invasive vitrectomy. The other treatment and follow-up were the same as those in the postoperative injection group except for conbercept injection. All patients underwent routine slit-lamp examination, indirect ophthalmoscope and B-ultrasound examination before operation. The main outcome measure included the time of operation, the incidence rate of iatrogenic retinal holes and silicone oil filling. 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引用次数: 0

摘要

目的观察微创玻璃体视网膜手术玻璃体内注射康柏西普治疗增殖性糖尿病视网膜病变并发玻璃体出血的疗效和安全性。方法前瞻性临床研究。本研究共招募了50例在天津医科大学眼科医院临床诊断为PDR并发玻璃体出血需要玻璃体切除术的患者。根据知情同意原则，将患者分为两组：术后注射组和对照组。术前对每组25例患者的25只眼睛进行检查。在后极和牵引性视网膜脱离中没有观察到明显的增殖性变化。两组患者年龄差异有统计学意义（t=-24.697，P=0.030），但性别差异无统计学意义（χ2=0.330，P=0.564），糖尿病病程差异无统计学价值（t=-1.144，P=0.258），logMAR BCVA差异无统计学影响（t=-0.148，P=0.883），晶状体状态差异无统计学差异（χ2=0.397，P=0.529），全视网膜激光光凝（χ2=1.333，P=0.248）。术后注射组在27G微创玻璃体切除术后立即玻璃体内注射康柏西普0.05ml（10mg/ml）。除康柏西普注射液外，其余治疗及随访均与术后注射组相同。所有患者术前均行常规裂隙灯检查、间接检眼镜检查和B超检查。主要疗效指标包括手术时间、医源性视网膜裂孔的发生率和硅油填充。术后1周、1个月、3个月和6个月记录玻璃体出血复发、BCVA、眼压、中央视网膜厚度（CRT）、术后并发症和进展情况。结果术后1周和1、3、6个月，两组logMAR BCVA差异有统计学意义（t=-4.980、-4.840、-4.892、-5.439；P<0.001），但两组间无统计学差异（χ2=3.0301.153；P=0.01920.103）。术后1周及1、3、6个月，术后注射组CRT低于对照组，差异有统计学意义（t=-2.622、-2.638、-3.613、-3.037；P=0.012、0.010、0.001、0.004、0.005），术后所有眼出现增殖性玻璃体视网膜病变、视网膜脱离、虹膜发红和新生血管性青光眼。结论术后玻璃体内注射康柏西普治疗PDR安全有效。它可以减少玻璃体切除术后玻璃体出血的复发，提高BCVA。关键词：糖尿病视网膜病变/并发症；玻璃体出血；血管生成抑制剂/治疗用途；玻璃体切除术

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Intravitreal injection of conbercept after operation in the treatment of proliferatived diabetic retinophathy complicated with vitreous hemorrhage

Objective To observe the efficacy and safety of intravitreal injection of conbercept in the treatment of proliferatived diabetic retinophathy (PDR) complicated with vitreous hemorrhage by minimally invasive vitreoretinal surgery. Methods Prospective clinical study. A total of 50 patients with PDR complicated with vitreous hemorrhage clinically diagnosed in Tianjin Medical University Eye Hospital who needed vitrectomy were recruited in this study. According to the principle of informed consent, the patients were divided into two groups: postoperative injection group and the control group. Twenty-five eyes of 25 patients in each group were examined before operation. No significant proliferative changes in the posterior pole and traction retinal detachment were observed. There was significant difference of age between two groups (t=-24.697, P=0.030), but no significant difference of sex (χ2=0.330, P=0.564), duration of diabetes (t=-1.144, P=0.258), logMAR BCVA (t=-0.148, P=0.883), lens state (χ2=0.397, P=0.529), panretinal laser photocoagulation (χ2=1.333, P=0.248). The postoperative injection group was treated with intravitreous injection of 0.05 ml conbercept (10 mg/ml) immediately after 27G minimally invasive vitrectomy. The other treatment and follow-up were the same as those in the postoperative injection group except for conbercept injection. All patients underwent routine slit-lamp examination, indirect ophthalmoscope and B-ultrasound examination before operation. The main outcome measure included the time of operation, the incidence rate of iatrogenic retinal holes and silicone oil filling. The recurrence of vitreous hemorrhage, BCVA, intraocular pressure, central retinal thickness (CRT), postoperative complications and progression were recorded 1 week, 1 month, 3 months and 6 months after operation. Results At 1 week and 1, 3, 6 months after operation, there was significant difference of logMAR BCVA between the two groups (t=-4.980, -4.840, -4.892, -5.439; P<0.001). At 3 and 6 months after operation, the recurrence of vitreous hemorrhage in the postoperative injection group was lower than that in the control group, but there was no statistical difference between two groups (χ2=3.030, 4.153; P=0.192, 0.103). At 1 week and 1, 3, 6 months after operation, the CRT in the postoperative injection group was lower than that in the control group, the difference was significant (t=-2.622, -2.638, -3.613, -3.037; P=0.012, 0.010, 0.001, 0.004, 0.005). There was no complications such as choroid detachment, proliferative vitreoretinopathy, retinal detachment, iris redness and neovascular glaucoma in all the eyes after operation. Conclusions Intravitreal injection of conbercept in the treatment of PDR after operation is safe and effective. It can reduce the recurrence of vitreous hemorrhage after vitrectomy, improve the BCVA. Key words: Diabetic retinopathy/complications; Vitreous hemorrhage; Angiogenesis inhibitors/therapeutic use; Vitrectomy

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来源期刊

中华眼底病杂志 Medicine-Ophthalmology

CiteScore

0.40

自引率

0.00%

发文量

5383

期刊介绍： Chinese Journal of Ocular Fundus Diseases is the only scientific journal in my country that focuses on reporting fundus diseases. Its purpose is to combine clinical and basic research, and to give equal importance to improvement and popularization. It comprehensively reflects the leading clinical and basic research results of fundus disease disciplines in my country; cultivates professional talents in fundus disease, promotes the development of fundus disease disciplines in my country; and promotes academic exchanges on fundus disease at home and abroad. The coverage includes clinical and basic research results of posterior segment diseases such as retina, uveal tract, vitreous body, visual pathway, and internal eye diseases related to systemic diseases. The readers are medical workers and researchers related to clinical and basic research of fundus diseases. According to the journal retrieval report of the Chinese Institute of Scientific and Technological Information, the comprehensive ranking impact factor and total citation frequency of the Chinese Journal of Ocular Fundus Diseases have been among the best in the disciplines of ophthalmology, otolaryngology, and ophthalmology in my country for many years. The papers published have been included in many important databases at home and abroad, such as Scopus, Peking University Core, and China Science Citation Database (CSCD).