中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2010年
2期
116-119
,共4页
王丽丽%张雯%李立婕%金丽英%霍敏%何斌
王麗麗%張雯%李立婕%金麗英%霍敏%何斌
왕려려%장문%리립첩%금려영%곽민%하빈
糖尿病视网膜病变/治疗%激光凝固术/方法%抗体%单克隆/药物作用
糖尿病視網膜病變/治療%激光凝固術/方法%抗體%單剋隆/藥物作用
당뇨병시망막병변/치료%격광응고술/방법%항체%단극륭/약물작용
Diabetic retinopathy/therapy%Laser coagulation/methods%Antibodies,monoclonal/drug effects
目的 观察玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)联合超全视网膜激光光凝(E-PRP)治疗高危型增生型糖尿病视网膜病变(PDR)的临床疗效.方法 对临床确诊的高危型PDR患者53例57只眼进行玻璃体腔注射bevacizumab(IVB)联合E-PRP治疗.所有患者治疗前后均常规进行视力、眼压、荧光素虹膜血管造影(IFA)以及荧光素眼底血管造影(FFA)检查、眼底照相.对比观察治疗前及治疗后视力、眼压、虹膜以及视网膜新生血管的消退情况.平均随访时间6个月.结果 IVB治疗前平均视力(0.143±0.072),治疗后7 d平均视力(0.218±0.128),与治疗前相比差异有统计学意义(t=-7.940,P<0.05).E-PRP治疗后1、3、6个月平均视力分别(0.228±0.138、0.223±0.125、0.220±0.134),与IVB前比较,差异均有统计学意义(P<0.05);与IVB后比较,差异无统计学意义(P>0.05).57只眼中有21只眼瞳孔缘及虹膜有新生血管者.IVB治疗前平均眼压(26.632±2.629)mm Hg(1 mm Hg=0.133 kPa),治疗后7 d平均眼压(19.316±3.092)mm Hg,与治疗前比较,差异均具有统计学意义(t=12.838,P<0.05).E-PRP治疗后1、3、6个月,眼压平均分别[(16.947±2.345)、(16.474±1.611)、(16.421±4.702)]mm Hg与IVB前、后比较,差异均具有统计学意义(P<0.05).IVB治疗后7 d,57只眼视盘及视网膜新生血管部分消退,血管渗漏明显减少或消失.其中瞳孔缘、虹膜表面新生血管者21只眼,新生血管消失,IFA检查结果显示渗漏明显减少.E-PRP治疗后2个月FFA检查结果显示,一次E-PRP有效率为68.4%,需追加激光者21.1%;其中10.5%未能控制病情行玻璃体手术.结论 IVB辅助E-PRP治疗高危PDR,可促使虹膜、视网膜新生血管迅速消退.减轻血管渗漏,阻止或预防并发症发生,高治疗效果.
目的 觀察玻璃體腔註射抗血管內皮生長因子單剋隆抗體bevacizumab(商品名Avastin)聯閤超全視網膜激光光凝(E-PRP)治療高危型增生型糖尿病視網膜病變(PDR)的臨床療效.方法 對臨床確診的高危型PDR患者53例57隻眼進行玻璃體腔註射bevacizumab(IVB)聯閤E-PRP治療.所有患者治療前後均常規進行視力、眼壓、熒光素虹膜血管造影(IFA)以及熒光素眼底血管造影(FFA)檢查、眼底照相.對比觀察治療前及治療後視力、眼壓、虹膜以及視網膜新生血管的消退情況.平均隨訪時間6箇月.結果 IVB治療前平均視力(0.143±0.072),治療後7 d平均視力(0.218±0.128),與治療前相比差異有統計學意義(t=-7.940,P<0.05).E-PRP治療後1、3、6箇月平均視力分彆(0.228±0.138、0.223±0.125、0.220±0.134),與IVB前比較,差異均有統計學意義(P<0.05);與IVB後比較,差異無統計學意義(P>0.05).57隻眼中有21隻眼瞳孔緣及虹膜有新生血管者.IVB治療前平均眼壓(26.632±2.629)mm Hg(1 mm Hg=0.133 kPa),治療後7 d平均眼壓(19.316±3.092)mm Hg,與治療前比較,差異均具有統計學意義(t=12.838,P<0.05).E-PRP治療後1、3、6箇月,眼壓平均分彆[(16.947±2.345)、(16.474±1.611)、(16.421±4.702)]mm Hg與IVB前、後比較,差異均具有統計學意義(P<0.05).IVB治療後7 d,57隻眼視盤及視網膜新生血管部分消退,血管滲漏明顯減少或消失.其中瞳孔緣、虹膜錶麵新生血管者21隻眼,新生血管消失,IFA檢查結果顯示滲漏明顯減少.E-PRP治療後2箇月FFA檢查結果顯示,一次E-PRP有效率為68.4%,需追加激光者21.1%;其中10.5%未能控製病情行玻璃體手術.結論 IVB輔助E-PRP治療高危PDR,可促使虹膜、視網膜新生血管迅速消退.減輕血管滲漏,阻止或預防併髮癥髮生,高治療效果.
목적 관찰파리체강주사항혈관내피생장인자단극륭항체bevacizumab(상품명Avastin)연합초전시망막격광광응(E-PRP)치료고위형증생형당뇨병시망막병변(PDR)적림상료효.방법 대림상학진적고위형PDR환자53례57지안진행파리체강주사bevacizumab(IVB)연합E-PRP치료.소유환자치료전후균상규진행시력、안압、형광소홍막혈관조영(IFA)이급형광소안저혈관조영(FFA)검사、안저조상.대비관찰치료전급치료후시력、안압、홍막이급시망막신생혈관적소퇴정황.평균수방시간6개월.결과 IVB치료전평균시력(0.143±0.072),치료후7 d평균시력(0.218±0.128),여치료전상비차이유통계학의의(t=-7.940,P<0.05).E-PRP치료후1、3、6개월평균시력분별(0.228±0.138、0.223±0.125、0.220±0.134),여IVB전비교,차이균유통계학의의(P<0.05);여IVB후비교,차이무통계학의의(P>0.05).57지안중유21지안동공연급홍막유신생혈관자.IVB치료전평균안압(26.632±2.629)mm Hg(1 mm Hg=0.133 kPa),치료후7 d평균안압(19.316±3.092)mm Hg,여치료전비교,차이균구유통계학의의(t=12.838,P<0.05).E-PRP치료후1、3、6개월,안압평균분별[(16.947±2.345)、(16.474±1.611)、(16.421±4.702)]mm Hg여IVB전、후비교,차이균구유통계학의의(P<0.05).IVB치료후7 d,57지안시반급시망막신생혈관부분소퇴,혈관삼루명현감소혹소실.기중동공연、홍막표면신생혈관자21지안,신생혈관소실,IFA검사결과현시삼루명현감소.E-PRP치료후2개월FFA검사결과현시,일차E-PRP유효솔위68.4%,수추가격광자21.1%;기중10.5%미능공제병정행파리체수술.결론 IVB보조E-PRP치료고위PDR,가촉사홍막、시망막신생혈관신속소퇴.감경혈관삼루,조지혹예방병발증발생,고치료효과.
Objective To evaluate the therapeutic effect of intravitreal injection with bevacizumab (Avastin) (IVB)combined with extra-panretinal photocoagulation (E-PRP) for high-risk proliferative diabetic retinopathy (PDR). Methods A total of 57 eyes of 53 patients with high-risk PDR underwent intravitreal injection combined with E-PRP. The examinations of vision acuity, intraoeular pressure, iris fluorescein angiography (IFA), fundus photos and fundus fluorescein angiography (FFA) were performed on all of the patients before and 1, 2, 3, and 6 months after the treatment; the results of the examinations before and after the treatment were compared and analyzed. The average follow up was 6 months. Results The mean visual acuity was (0. 143 ± 0. 072) before the treatment and (0. 218 ± 0. 128) 7 days after the tretment; the difference was significant (t= -7. 940, P<0.05). The mean visual acuity 1, 3, and 6 months after E-PRP (0. 228± 0. 138, 0. 223 ± 0. 125, 0. 220 ± 0. 134, respectively) differed much from that before IVB (P<0. 05), but not so much from that after IVB (P>0.05). The mean intraoeular pressure of 21 eyes which had the neovascularization of pupil margin and iris surface before and 7 days after IVB was (26. 632±2. 629) and (19. 316±3. 092) mm Hg (1 mm Hg=0. 133 kPa), respectively; the difference was significant (t=12. 838, P<0. 05) . The mean intraocular pressure 1, 3, and 6 months after E-PRP was (16. 947±2. 345), ( 16.474 ± 1.611 ), and (16. 421±4. 702 )mm Hg, respectively, which differed much from that before and after IVB (P<0. 05). Neovascularization on the disc and the retinae of 57 eyes were subsided partly, and a significant reduction or disappeared of the area of retinal neovascularization and the blood vessel leakage were observed 7 days after IVB. The neovascularization of pupil margin and iris surface of 21 eyes disappeared, and the IFA leakage decreased. The results of FFA 2 months after E-PRP showed that the one-off efficiency of E-PRP was 68.4%; 12 eyes (21.1%) needed an additional laser, in which 6 eyes (10.5 %) underwent vitreous surgery. Conclusion IVB combined with E-PRP as a treatment for high-risk PDR may improve the regression of retinal neovascularization and the reduction of vascular permeability, and prevent or reduce the complications and improve the therapeutic effect.
