术前玻璃体腔注射康柏西普联合玻璃体切割术治疗增殖性糖尿病视网膜病变的疗效

Preoperative intravitreal injection of Conbercept combined with pars plana vitrectomy in the treatment of proliferative diabetic retinopathy

摘要:

目的：探讨术前玻璃体腔注射康柏西普联合玻璃体切割术(PPV)治疗增殖性糖尿病视网膜病变(PDR)疗效及其对房水炎症因子的影响。

方法：采用非随机临床对照试验设计。收集2019-03/2022-01就诊于本院的PDR患者100例100眼(双眼发病时取程度较重眼入组，如双眼程度一致则取右眼入组)的临床资料，按照患者治疗意愿分为对照组48例48眼仅行PPV，联合组52例52眼术前玻璃体腔注射康柏西普联合PPV，术后随访12mo。记录两组患者手术时间、手术前后最佳矫正视力BCVA(LogMAR)、黄斑中心凹视网膜厚度(CRT)及术后并发症发生情况。比较两组患者房水炎症因子IL-6、IL-10、IFN-γ及TNF-α水平。

结果：联合组患者PPV术前房水炎症因子IL-6、IL-10、IFN-γ及TNF-α水平、手术时间、术中电凝止血数、医源性视网膜裂孔数及硅油填充眼数均低于对照组(均P<0.05)。两组患者术前BCVA和CRT比较均无差异(均P>0.05)，术后1、6、12mo BCVA和CRT均较术前改善，联合组改善优于对照组(均P<0.05)。联合组术后12mo并发症发生率低于对照组(11.5% vs 35.4%，P<0.05)。两组的PDR复发率比较，差异无统计学意义(P>0.05)。

结论：术前玻璃体腔注射康柏西普联合PPV治疗PDR疗效显著，可缩短手术时间、抑制炎症效应、减少术后并发症，更有助于患者视力提高。

Abstract:

AIM: To investigate the efficacy of pars plana vitrectomy(PPV)combined with preoperative intravitreal injection of conbercept in the treatment of proliferative diabetic retinopathy(PDR)and its effect on aqueous humor inflammatory factors.

METHODS: A non-randomized controlled clinical trial was designed. The clinical data of 100 patients(100 eyes)with PDR who were admitted to the hospital from March 2019 to January 2022 were collected(the heavier eye was selected when both eyes had PDR, while the right eye was selected when the PDR degree was the same)and divided into control group and combined group according to their treatment wishes. The 48 eyes in the control group received PPV alone, and 52 eyes in the combined group received intravitreal injection of conbercept combined with PPV. Follow-up period was 12mo. The operative time, pre-and post-operative best corrected visual acuity(BCVA LogMAR), central retinal thickness(CRT)and postoperative complications in the two groups were statistically analyzed. And the levels of inflammatory factors(IL-6, IL-10, IFN-γ and TNF-α)in aqueous humor were compared between the two groups.

RESULTS: Compared with the control group, the levels of inflammatory factors IL-6, IL-10, IFN-γ and TNF-α in aqueous humor in combination group were significantly decreased. The operation time of the combined group was significantly shorter than that of the control group, and the number of electrocoagulation, iatrogenic retinal hole and silicone oil filling were less in the combined group than those in the control group(all P<0.05). There was no significant difference in preoperative BCVA and CRT between the two groups(all P>0.05). The BCVA and CRT improved at 1, 6 and 12mo after surgery in both groups, but the improvement was more significant in the combined group(all P<0.05). The postoperative incidence of complications in the combined group were lower than that in the control group(11.5% vs. 35.4%, P<0.05). There was no significant difference in the recurrence rate of PDR between the two groups(P>0.05).

CONCLUSIONS: Intravitreal injection of conbercept combined with PPV in the treatment of PDR has a significant effect, which can shorten the operation time, inhibit the inflammatory effect, reduce postoperative complications, and contribute to the improvement of patients' vision.