CAJ | 학술논문

目的对比观察玻璃体切除术(pars plana vitrectomy,PPV)联合应用或不应用雷珠单抗玻璃体注射(intravitreal ranibizumab,IVR),对增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者手术中操作及术后预后的影响.方法前瞻性对照性研究.将2013年2～6月在沈阳军区总医院眼科就诊的34例(37只眼)合并牵拉性视网膜脱离的PDR患者,分为雷珠单抗玻璃体注射联合玻璃体切除术(IVR/PPV)组及单纯玻璃体切除术(PPV)组.IVR/PPV组术前1周注射雷珠单抗0.5 mg.观察两组手术中出血量(积液盒红细胞平均计数)、手术时间、术后短、长期再出血发生率及视力预后的差异.结果随访6个月,总共29例(31只眼)最终纳入研究,其中IVR/PPV组12只眼,单纯PPV组19只眼.IVR/PPV组术中出血量(平均红细胞计数)为(79±62.24)×106/mL,显著低于单纯PPV组的(156.54±123.2) ×106/mL,差异有统计学意义(t=2.315,P=0.028),手术时间(79.47± 15.44) min也显著低于单纯PPV组(102.08±22.2) min,差异有统计学意义(t=3.087,P=0.006).两组患者术后视力均较术前显著提高,差异有统计学意义(t =4.92,5.75;P=0.01,0.000),但两组间的视力预后及术后再出血发生率差异均无统计学意义(P＞0.05).结论术前雷珠单抗玻璃体注射,能显著减少PDR患者玻璃体切除手术中出血及手术时间,为复杂糖尿病史网膜患者的手术治疗提供了便利.
목적 대비관찰파리체절제술(pars plana vitrectomy,PPV)연합응용혹불응용뢰주단항파리체주사(intravitreal ranibizumab,IVR),대증식성당뇨병시망막병변(proliferative diabetic retinopathy,PDR)환자수술중조작급술후예후적영향.방법 전첨성대조성연구.장2013년2～6월재침양군구총의원안과취진적34례(37지안)합병견랍성시망막탈리적PDR환자,분위뢰주단항파리체주사연합파리체절제술(IVR/PPV)조급단순파리체절제술(PPV)조.IVR/PPV조술전1주주사뢰주단항0.5 mg.관찰량조수술중출혈량(적액합홍세포평균계수)、수술시간、술후단、장기재출혈발생솔급시력예후적차이.결과 수방6개월,총공29례(31지안)최종납입연구,기중IVR/PPV조12지안,단순PPV조19지안.IVR/PPV조술중출혈량(평균홍세포계수)위(79±62.24)×106/mL,현저저우단순PPV조적(156.54±123.2) ×106/mL,차이유통계학의의(t=2.315,P=0.028),수술시간(79.47± 15.44) min야현저저우단순PPV조(102.08±22.2) min,차이유통계학의의(t=3.087,P=0.006).량조환자술후시력균교술전현저제고,차이유통계학의의(t =4.92,5.75;P=0.01,0.000),단량조간적시력예후급술후재출혈발생솔차이균무통계학의의(P＞0.05).결론 술전뢰주단항파리체주사,능현저감소PDR환자파리체절제수술중출혈급수술시간,위복잡당뇨병사망막환자적수술치료제공료편리.
Objective To assess the effect of pars plana vitrectomy (PPV) with or without preoperative intravitreal ranibizumab (IVR) injection for treatment of proliferative diabetic retinopathy (PDR).Methods A prospective study was carried out with consecutive patients with diabetic traction retinal detachment which were underwent PPV at our department from February 2013 to June 2013.Thirty-four patients (37 eyes) were assigned to PPV only (PPV group) or PPV combined with one IVR (0.5mg/0.05ml) injection 1 week prior to surgery (IVR/PPV group).The main outcomes included intraoperative intraocular hemorrhage (measured with erythrocyte count in the fluid retrieved from the vitrectomy cassette using a Neubauer chamber),time of vitrectomy,postvitrectomy vitreous hemorrhage (VH) and visual acuity were assessed.All patients were followed up 6 months.Results A total of 29 patients (31 eyes) fulfilled the study included 12 eyes in the PPV group and 19 eyes in the IVR/PPV group.The mean erythrocyte count in the IVR/PPV group were 79±62.24×106 cells/ml,significantly lowed than 156.54±123.2×106 cells/ml in the PPV group (t =2.315,P =0.028).The mean time of vitrectomy in the IVR/PPV group was 79.47± 15.44 minutes,also significantly lowed than 102.08±22.2 minutes in the PPV groups (t =3.087,P =0.006).The postoperative visual acuity (VA) at 6 months in two groups were all significantly increased than preoperative VA respectively (t =4.92,5.75 P =0.001,0.000).The incidences of postvitrectomy VH (whatever early VH or late VH) and postoperative VA at 6 months had no difference significantly between 2 groups.Conclusions Preoperative intravitreal ranibizumab significantly decrease intraoperative hemorrhage and time of vitrectomy,ease the procedure of operation in complex PDR patients.