CAJ | 학술논문

目的探讨玻璃体腔注射Avsstin对晚期增生性糖尿病视网膜病变手术难度的改善、术中眼内填充的选择、手术并发症的发生及疗效情况.方法 2008年7至12月,对晚期增生性糖尿病视网膜病变的病人38例38只眼术前先行玻璃体腔注射Avastin0.06ml(注射组),然后行手术治疗.选择2008年1至6月未进行玻璃体腔注射Avastin的晚期增生性糖尿病视网膜病变的病人47例47只眼作对照(非注射组).观察:(1)注射组与非注射组患者手术中出血情况,医源性裂孔发生率及增殖膜剥除的彻底性;(2)术中需要行硅油填充的比例;(3)术后再出血、再增殖等的发生情况;(4)手术后病人的视力.结果注射组较大量出血2只眼,5.3%;非注射组20只眼,42.6%(P<0.05).注射组医源性裂孔3只眼,6.4%;非注射组12只眼,25.5%(P<0.05).注射组增殖膜都能彻底剥除,非注射组4只眼进行膜分割,有膜蒂残留.注射组术中2只眼需要硅油填充,5.3%,非注射组11只眼需要硅油填充,23.4%(P<0.05 ).注射组术后有1只眼出现Ⅲ级玻璃体反应,非注射组有4只眼.随访期内,注射组没有再出血的病例,非注射组再出血6只眼,12.8%.注射组术后没有再增殖的病例,非注射组有2只眼因再增殖需再次手术治疗.术后视力注射组为光感至0.2,非注射组为光感至0.1,两组间差异没有统计学意义,但注射组和非注射组术前术后视力均有统计学差异,其P值分别为0.043和0.046.结论在晚期增生性糖尿病视网膜病变手术前玻璃体腔注射Avastin,能有效控制手术中的出血、膜剥离不彻底、医源性裂孔等并发症的发生,减少硅油填充的比例,减少术后玻璃体冉出血及增殖,大大降低了手术的风险,提高了手术的成功率.
목적 탐토파리체강주사Avsstin대만기증생성당뇨병시망막병변수술난도적개선、술중안내전충적선택、수술병발증적발생급료효정황.방법 2008년7지12월,대만기증생성당뇨병시망막병변적병인38례38지안술전선행파리체강주사Avastin0.06ml(주사조),연후행수술치료.선택2008년1지6월미진행파리체강주사Avastin적만기증생성당뇨병시망막병변적병인47례47지안작대조(비주사조).관찰:(1)주사조여비주사조환자수술중출혈정황,의원성렬공발생솔급증식막박제적철저성;(2)술중수요행규유전충적비례;(3)술후재출혈、재증식등적발생정황;(4)수술후병인적시력.결과 주사조교대량출혈2지안,5.3%;비주사조20지안,42.6%(P<0.05).주사조의원성렬공3지안,6.4%;비주사조12지안,25.5%(P<0.05).주사조증식막도능철저박제,비주사조4지안진행막분할,유막체잔류.주사조술중2지안수요규유전충,5.3%,비주사조11지안수요규유전충,23.4%(P<0.05 ).주사조술후유1지안출현Ⅲ급파리체반응,비주사조유4지안.수방기내,주사조몰유재출혈적병례,비주사조재출혈6지안,12.8%.주사조술후몰유재증식적병례,비주사조유2지안인재증식수재차수술치료.술후시력주사조위광감지0.2,비주사조위광감지0.1,량조간차이몰유통계학의의,단주사조화비주사조술전술후시력균유통계학차이,기P치분별위0.043화0.046.결론 재만기증생성당뇨병시망막병변수술전파리체강주사Avastin,능유효공제수술중적출혈、막박리불철저、의원성렬공등병발증적발생,감소규유전충적비례,감소술후파리체염출혈급증식,대대강저료수술적풍험,제고료수술적성공솔.
Objective To evaluate the efficacy of vitrectomy assisted with preoperative intravitreal injection of Avastin for severe proliferative diabetic retinopathy.Methods Thirty-eight cases (thirty-eight eyes) with severe proliferative diabetic retinopathy Were treated by vitrectomy assisted with preoperative inteaviaveal injection of Avastin.Forty-seven cases (forty-seven eyes) with severe proliferative diabetic retinopathy treated by vitreetomy were analyzed as control group.Hemorrhage during the operation,risks of iatrogenic hole,per- centage of silicone oil tamponade,rebleeding and proliferation postoperative and visual acuity postoperative were observed.Results Obvious hemorrhage during the operation were observed in 2 eyes in the Avastin group(5.3%)and 20 eyes in the control group(42.6%)(P<0.05).The risk of iatrogenic hole of Avastin group and control group were 6.4%(3 eyes) and 25.5%(12 eyes) respectively.(P<0.05).The proliferative mere- brane of the Avastin group Was more easily removed than that of the control group.Two eyes of the Avastin group and eleven eyes of the control group needed silicon oil tamponade.There Were no cases rebleeding post- operative in the Avastin group but there were six eyes rebleeding in the control group.Two eyes of the control group proliferated again postoperatively and needed vitrectomy once more.The visual acuity postoperative of Avastin group and the control group were LP～0.2 and LP～0.1 respectively.There was no statistic difference during the two groups.Conclusion Vitrectomy assisted with preoperative inwavitreal injection of Avastin was benefic for severe proliferative diabetic retinopathy.