雷珠单抗辅助微创玻璃体切割术治疗严重PDR的临床研究

Clinical observation of minimally invasive vitrectomy assisted by Ranibizumab on severe proliferative diabetic retinopathy

摘要:

目的：观察雷珠单抗(Ranibizumab)辅助微创玻璃体切割术(pars plana vitrectomy，PPV)治疗严重增生性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)的临床疗效。

方法：选取2014-06/2016-07在我院就诊且行23G/25G微创玻璃体切割治疗的严重PDR患者56例56眼的临床资料进行回顾性分析，将术前5～7d行玻璃体腔注射雷珠单抗(intravitreal injection of ranibizumab，IVR，0.5mg/0.05mL)且联合微创PPV者30眼分为A组，将接受单纯微创PPV者26眼分为B组。统计分析两组患者术眼手术操作持续时间、术中出血情况、术中使用电凝次数、医源性视网膜裂孔发生率和术后最佳矫正视力(best corrected visual acuity，BCVA)的差异。术后随访6mo。

结果：A组患者手术时间明显短于B组，两组比较差异有统计学意义(98.10±14.23min vs 113.89±17.66min，t=3.703，P=0.0005)。术中A组患者出血眼数明显少于B组，两组比较差异有统计学意义(20% vs 54%，χ²=6.95，P=0.0084)。A组患者术中平均使用电凝次数明显少于B组，两组比较差异有统计学意义(1.30±1.15次vs 2.73±1.71次，t=3.72，P=0.001)。术中A组患者医源性视网膜裂孔发生率明显少于B组，两组比较差异有统计学意义(7% vs 27%，χ²=4.24，P=0.0396)。术后1mo时A组BCVA提高率较B组高，但两组比较差异无统计学意义(87% vs 73%，χ²=1.630，P=0.202)。

结论：雷珠单抗辅助微创玻璃体切割术治疗严重PDR可降低术中出血，减少术中电凝使用次数，明显缩短手术时间，减少医源性视网膜裂孔的发生率，而术后最佳矫正视力提高率与单纯微创玻璃体切割术组比较无明显差异。

Abstract:

AIM: To investigate the clinical efficacy of 23G /25G minimally invasive vitrectomy assisted by intravitreal injection of Ranibizumab(IVR)in the treatment of severe proliferative diabetic retinopathy(PDR).

METHODS: The respective analysis of 56 eyes of 56 patients with severe PDR treated by minimally invasive vitrectomy from June 2014 to July 2016 was performed. Thirty eyes treated by IVR-assisted minimally invasive vitrectomy as Group A and 26 eyes treated by minimally invasive vitrectomy only as Group B. IVR(0.5mg/0.05mL)was performed on the eyes 5-7d before PPV in Group A. Operative duration, hemorrhage during the operation, endodiathermy times, incidence of iatrogenic retinal holes and best corrected visual acuity(BCVA)between the two groups were observed. The follow-up period was 6mo.

RESULTS: The average operation time in Group A was 98.10 ± 14.23min, Group B was 113.89±17.66min, the difference was statistically significant(t=3.703, P=0.0005). Hemorrhage during the operation was observed in 6 eyes in Group A(20%)and 14 eyes in Group B(54%), the difference was statistically significant(χ²=6.95, P=0.0084). Endodiathermy time in Group A was significantly less than in Group B(1.30±1.15 vs 2.73±1.71; t=3.72, P=0.001). The incidence of iatrogenic retinal holes was observed in 2 eyes in Group A(7%)and 7 eyes in Group B(27%). The difference was statistically significant(χ²=4.24, P=0.0396)in the two groups. The BCVA at post-operation 1mo was significantly improved in comparison with pre-operation, but no significant difference in the post-operative BCVA between the two groups(87% vs 73%; χ²=1.630, P=0.202).

CONCLUSION: Minimally invasive vitrectomy assisted with the preoperative intravitreal injection of ranibizumab in the treatment of severe PDR can effectively shorten the operation time, lessen the incidence of hemorrhage, endodiathermy time and iatrogenic retinal holes. No significant difference in the post-operative BCVA between the two groups.