雷珠单抗辅助玻璃体切割术治疗增殖型糖尿病视网膜病变患者的疗效

doi:10.3760/cma.j.issn.1007-1245.2024.11.029

摘要/Abstract

摘要：

目的　观察玻璃体内注射雷珠单抗辅助玻璃体切割术对增殖型糖尿病视网膜病变（PDR）患者治疗效果及手术并发症的影响。方法　回顾性分析，选取2022年6月至2023年10月期间在吉林省人民医院就诊的45例（45眼）PDR患者作为研究对象，根据治疗方式不同分为对照组24例（24眼）和试验组21例（21眼）。对照组男17例、女7例，年龄（57.46±9.14）岁，糖尿病病程（8.08±4.75）年，仅接受玻璃体切割术；试验组男11例、女10例，年龄（52.09±10.20）岁，糖尿病病程（10.00±3.61）年，在行玻璃体切割术前1周接受0.05 ml的雷珠单抗注射液眼内注射治疗。对比两组患者基本资料、手术完成时间（均为玻璃体切割术）、术中数据（医源性裂孔、电凝使用、眼内惰性气体及硅油填充、术中明显出血发生率）及并发症发生情况，并对术前和术后1个月、3个月的最佳矫正视力（BCVA）进行评估。采用t检验、χ²检验。结果　两组患者基本资料比较，差异均无统计学意义（均P>0.05）。试验组手术完成时间、医源性裂孔、电凝使用、眼内惰性气体及硅油填充、术中明显出血发生率均低于对照组［（51.00±5.65）min比（71.29±6.19）min、9.52%（2/21）比45.83%（11/24）、4.76%（1/21）比41.67%（10/24）、14.29%（3/21）比50.00%（12/24）、4.76%（1/21）比33.33%（8/24）］，差异均有统计学意义（t=11.426，χ²=5.529、6.382、4.922、4.068，均P<0.05）。两组患者术前、术后1个月及3个月的BCVA比较，差异均无统计学意义（均P>0.05）；术后1个月及3个月，两组患者BCVA较术前均有所提高，差异均有统计学意义（t=7.656、9.603、5.090、10.325，均P<0.05）。术后随访3个月，两组患者术后早期（≤1个月）出现的玻璃体内出血状况、高眼压情况和总并发症发生率比较，差异均无统计学意义（均P>0.05）；两组患者术后晚期（>1个月）出现的玻璃体内出血状况比较，差异有统计学意义（t=4.564，P<0.05）。结论　玻璃体内注射雷珠单抗有助于减少PDR患者玻璃体切割术中并发症发生率，缩短手术时间，改善患者术后BCVA。

关键词:

增殖型糖尿病视网膜病变, 雷珠单抗, 玻璃体切割术

Abstract:

Objective　To observe the effect of pars plana vitrectomy (PPV) with intravitreal injection of ranibizumab injection as adjuvant for patients with proliferative diabetic retinopathy (PDR) and its influence on surgical complications. Methods　Forty-five patients with PDR (45 eyes) treated in Jilin Provincial People's Hospital from June 2022 to October 2023 were selected as the study objects. The patients were divided into a control group (24 cases and 24 eyes) and an experimental group (21 cases and 21 eyes) according to the different treatment methods. There were 17 males and 7 females in the control group; they were (57.46±9.14) years old; their disease course was (8.08±4.75) years. There were 11 males and 10 females in the experimental group; they were (52.09±10.20) years old; their disease course was (10.00±3.61) years. The control group took PPV; in addition, the experimental group were intraocularly injected 0.05 ml ranibizumab injection one week before the surgery. The basic data, operation times, intraoperative data (incidences of iatrogenic hole, using electrocoagulation, intraocular filling with inert gas and silicone oil, and significant intraoperative bleeding), and incidences of surgical complications were compared between the two groups. The best corrected visual acuities (BCVA) before and 1 and 3 months after the surgery were evaluated. t and χ² tests were applied. Results　There were no statistical differences in the basic data between the two groups (all P>0.05). The operation time and incidences of iatrogenic hole, using electrocoagulation, intraocular filling with inert gas and silicone oil, and significant intraoperative bleeding in the experimental group were lower than those in the control group [(51.00±5.65) min vs. (71.29±6.19) min, 9.52% (2/21) vs. 45.83% (11/24), 4.76% (1/21) vs. 41.67% (10/24), 14.29% (3/21) vs. 50.00% (12/24), and 4.76% (1/21) vs. 33.33% (8/24)], with statistical differences (t=11.426; χ²=5.529, 6.382, 4.922, and 4.068; all P<0.05). There were no statistical differences in the BCVA before and 1 and 3 months after the surgery between the two groups (all P>0.05). The BCVA 1 and 3 months after the surgery were lower than those before the surgery in both groups, with statistical differences (t=7.656, 9.603, 5.090, and 10.325; all P<0.05). The patients were followed up for 3 months; there were no statistical differences in the early hemorrhage (≤1 month) and total incidence of complications (both P>0.05), but was in late hemorrhage (> 1 month) (t=4.564; P<0.05) between the two groups. Conclusions　Intravitreal injection of ranibizumab can reduce the incidence of complications during PPV for patients with PDR, shorten the operation time, and improve their BCVA after surgery.

Key words:

Proliferative diabetic retinopathy, Ranibizumab, Pars plana vitrectomy

易伟赵洁杨帆米倩倩程悦王丹.

雷珠单抗辅助玻璃体切割术治疗增殖型糖尿病视网膜病变患者的疗效 [J]. 国际医药卫生导报, 2024, 30(11): 1904-1908.

Yi Wei, Zhao Jie, Yang Fan, Mi Qianqian, Cheng Yue, Wang Dan.

Pars plana vitrectomy with ranibizumab as adjuvant for patients with proliferative diabetic retinopathy [J]. International Medicine and Health Guidance News, 2024, 30(11): 1904-1908.

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