摘要
目的探讨雷珠单抗辅助微切口白内障超声乳化联合23G玻璃体切割术治疗白内障合并增殖性糖尿病视网膜病变(PDR)的效果。方法选取郑州大学附属洛阳中心医院2015年8月至2018年8月收治的60例(72眼)白内障合并PDR患者,依照患者自愿原则选择治疗方式,根据治疗方式将患者分为对照组27例(32眼)和观察组33例(40眼)。对照组给予微切口白内障超声乳化联合23G玻璃体切割术治疗,观察组在对照组治疗的基础上辅助应用雷珠单抗,评价两组患者术前及术后1周、1个月及3个月的视力改善情况,黄斑中心凹视网膜厚度(CMT),比较两组术前及术后1周的血清生化指标,观察两组并发症情况。结果术后1周、1个月、3个月,两组患者视力逐渐提高,均高于术前(P均<0.05),组内不同时间点比较差异有统计学意义(P<0.05),观察组变化幅度大于对照组(P<0.05);观察组视力提高率可达80.00%,高于对照组(53.13%,P<0.05);术后1周、1个月、3个月,观察组组内不同时间点的CMT无显著变化(P>0.05),对照组的CMT则逐渐提高,高于术前(P<0.05),对照组组内不同时间点和组间同一时间点比较差异有统计学意义(P<0.05);术后1周,两组患者的血清血管内皮生长因子(VEGF)、半胱氨酸蛋白酶抑制物C(CysC)、生长停滞特异性基因产物6(Gas6)水及基质细胞衍生因子1(SDF-1)水平较治疗前降低(P<0.05),观察组降低幅度大于对照组(P<0.05);观察组术中大量出血、术中医源性视网膜裂孔、术后玻璃体再积血、术后高眼压及术后虹膜新生血管(INV)的并发症发生率分别为2.50%、2.50%、10.00%、5.00%、7.50%,低于对照组(15.63%、18.75%、31.25%、18.75%、28.13%,P<0.05)。结论雷珠单抗辅助微切口白内障超声乳化联合23G玻璃体切割术治疗白内障合并PDR患者,能明显提高患者视力,避免CMT增加,且能有效降低血清VEGF、CysC、GAS6及SDF-1水平,降低并发症风险,临床应用安全可靠。
Objective To explore the efficacy of ranibizumab-assisted micro-incision phacoemulsification combined with 23G vitrectomy in the treatment of cataract with proliferative diabetic retinopathy(PDR).Methods Sixty patients(72 eyes)with cataract complicated with PDR in Luoyang Central Hospital Affiliated to Zhengzhou University from August 2015 to August 2018 were collected.The patients were divided into control group(27 cases,32 eyes)and observation group(33 cases,40 eyes)according to the voluntary principle of patients.The visual acuity improvement and macullar central retinal thickness(CMT)in macular area were evaluated in the two groups before and 1 week,1 month and 3 months after surgery.The serum biochemical parameters were compared between the two groups before and 1 week after surgery.The complications were observed in the two groups.Results One week,1 month and 3 months after surgery,the visual acuity in the two groups was gradually increased,which were higher than those before surgery(P<0.05),and the difference was significant at different time points within the groups(P<0.05),and the change in observation group was significantly greater than that in control group(P<0.05).The improvement rate of visual acuity in observation group was significantly higher than that in control group(80.00%vs.53.13%,P<0.05).One week,1 month and 3 months after surgery,there was no significant change in the CMT at different time points in observation group(P>0.05),and in control group was gradually increased,which was significantly higher than that before surgery(P<0.05),and there was significant difference at different time points in control group and between the groups at the same time point(P<0.05).One week after surgery,the levels of serum vascular endothelial growth factor(VEGF),cystatin C(CysC),growth arrest-specific gene 6(Gas6)and stromal cell-derived factor 1(SDF-1)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decreases in observation group were greater than those in control group(P<0.05).The incidence rates of complications of intraoperative massive hemorrhage,intraoperative iatrogenic retinal tears,postoperative vitreous re-hemorrhage,postoperative intraocular hypertension and postoperative iris neovascularization(INV)were 2.50%,2.50%,10.00%,5.00%and 7.50%respectively in observation group,which were significantly lower than those in control group with 15.63%,18.75%.31.25%,18.75%and 28.13%(P<0.05).Conclusions Ranibizumab-assisted micro-incision phacoemulsification combined with 23G vitrectomy for patients with cataract and PDR can significantly improve the visual acuity of patients,avoid the increase of CMT,and effectively reduce the levels of serum VEGF,CysC,GAS6 and SDF-1,and reduce the risk of complications,with safe and reliable clinical application.
作者
韩少平
樊冬生
陈阳
侯敏
曹雨露
Han Shaoping;Fan Dongsheng;Chen Yang;Hou Min;Cao Yulu(Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China)
出处
《中国实用医刊》
2020年第6期72-77,共6页
Chinese Journal of Practical Medicine
