CAJ | 학술논문

目的观察玻璃体腔注射雷珠单抗(IVR)、全视网膜激光光凝(PRP)对增生型糖尿病视网膜病变(PDR)玻璃体切割手术及治疗效果的影响.方法临床确诊为PDR并行23G玻璃体切割手术治疗的60例患者78只眼纳入研究.玻璃体切割手术前行IVR治疗者22例28只眼(A组),行PRP治疗者18例20只眼(B组),未行IVR、PRP治疗者20例30只眼(C组).对比观察3组患者玻璃体切割手术时间、医源性裂孔、眼内填充硅油、应用电凝止血、手术后出血等情况以及手术后3个月的最佳矫正视力(BCVA).结果 A、B、C组平均手术时间分别为(67.429±11.243)、(77.762±10.435)、(106.839±20.724) min;A、B组平均手术时间均较C组缩短,差异均有统计学意义(t=8.940、5.928,P＜0.05).A、B、C组手术中应用电凝止血者分别为5、6、24只眼,A、B组手术中应用电凝止血的眼数较C组明显偏少,差异均有统计学意义(x2=19.955、10.505,P＜0.05).A、B、C组手术中填充硅油者分别为4、3、23只眼,A、B组手术中填充硅油的眼数较C组明显偏少,差异均有统计学意义(x2 =18.099、14.083,P＜0.05).A、B、C组手术中发生医源性裂孔及手术后出血的眼数比较,差异均无统计学意义(P＞0.05).手术后3个月,A、B、C组患眼平均BCVA分别为0.383±0.122、0.251士0.067、0.104士0.044;A、B组患眼平均BCVA均较C组提高,差异均有统计学意义(t=11.909、13.616,P＜0.05).结论玻璃体切割手术前应用IVR或PRP治疗PDR可缩短手术时间,减少手术中出血及眼内填充物的使用几率,提高患眼视力.
목적 관찰파리체강주사뢰주단항(IVR)、전시망막격광광응(PRP)대증생형당뇨병시망막병변(PDR)파리체절할수술급치료효과적영향.방법 림상학진위PDR병행23G파리체절할수술치료적60례환자78지안납입연구.파리체절할수술전행IVR치료자22례28지안(A조),행PRP치료자18례20지안(B조),미행IVR、PRP치료자20례30지안(C조).대비관찰3조환자파리체절할수술시간、의원성렬공、안내전충규유、응용전응지혈、수술후출혈등정황이급수술후3개월적최가교정시력(BCVA).결과 A、B、C조평균수술시간분별위(67.429±11.243)、(77.762±10.435)、(106.839±20.724) min;A、B조평균수술시간균교C조축단,차이균유통계학의의(t=8.940、5.928,P＜0.05).A、B、C조수술중응용전응지혈자분별위5、6、24지안,A、B조수술중응용전응지혈적안수교C조명현편소,차이균유통계학의의(x2=19.955、10.505,P＜0.05).A、B、C조수술중전충규유자분별위4、3、23지안,A、B조수술중전충규유적안수교C조명현편소,차이균유통계학의의(x2 =18.099、14.083,P＜0.05).A、B、C조수술중발생의원성렬공급수술후출혈적안수비교,차이균무통계학의의(P＞0.05).수술후3개월,A、B、C조환안평균BCVA분별위0.383±0.122、0.251사0.067、0.104사0.044;A、B조환안평균BCVA균교C조제고,차이균유통계학의의(t=11.909、13.616,P＜0.05).결론 파리체절할수술전응용IVR혹PRP치료PDR가축단수술시간,감소수술중출혈급안내전충물적사용궤솔,제고환안시력.
Objective To observe the different effect of 23G vitrectomy surgery assisted with intravitreal injection of ranibizumab and pan-retina photocoagulation in severe proliferative diabetic retinopathy (PDR) treatment.Methods A total of 60 patients (78 eyes) with severe PDR diagnosed were enrolled and divided into intravitreal injection of Lucentis group (Group A,22 patients,28 eyes),pan-retina photocoagulation group (Group B,18 patients,20 eyes) and control group (Group C,20 patients,30 eyes),all of them received 23G vitreoretinal surgery.The average operation time,iatrogenic hiatus,the use of filler and electric coagulation,postoperative bleeding and best corrected visual acuity in three months were comparatively analyzed among the three groups.Results The operation time in the three group was (67.429± 11.243),(77.762± 10.435),(106.839 ± 20.724) min respectively,the differences of A vs C and B vs C were statistically significant(t=8.940,5.928;P＜0.05).Five eyes needed electric coagulation in Group A,6 eyes in Group B,and 24 eyes in Group C,the differences of A vs C and B vs C were all statistically significant (x2=19.955,10.505;P＜0.05).Four eyes used the filler in Group A,3 eyes in Group B,and 23 eyes in Group C,the differences of A vs C and B vs C were all statistically significant (x2=18.099,14.083;P＜0.05).The difference of iatrogenic hiatus and postoperative bleeding was no significance among the three groups (P＞0.05).The best corrected visual acuity of 3 months after surgery in the three group is (0.383±0.122),(0.251±0.067),(0.1044-0.044) respectively,the differences of A vs C and B vs C were all statistically significant(t=11.909,13.616;P＜0.05).Conclusion The intravitreaI injection of ranibizumab or pan-retina photocoagulation treatment before the vitrectomy surgery is very effective,both of them can shorten the operation time,reduce electric coagulation and use of filler,and improve patients' eyesight.