增殖性糖尿病视网膜病变围手术期玻璃体腔内注射康柏西普的疗效研究

发布时间：2018-04-12 07:05

本文选题：增殖性糖尿病视网膜病变 + 康柏西普　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:对比观察单行经睫状体平坦部闭合式三通道23G玻璃体切除术(Pars plana vitrectomy,PPV)与玻璃体腔内注射康柏西普联合23G玻璃体切除术对增殖性糖尿病视网膜病变(Proliferative diabetic retinopathy,PDR)的手术操作及临床效果的影响。方法:回顾性病例分析。从2014-12/2015-12我院收治的PDR患者中随机选取23例26眼。按照随机法将其分为两组,对照组:共11例12眼,入院后单行经睫状体平坦部闭合式三通道23G玻璃体切除术治疗;试验组:共12例14眼,入院后先于玻璃体腔内注射康柏西普0.5mg/0.05ml,注射后6-8d行23G玻璃体切除术。记录两组PDR患者术前基本情况(如性别、年龄、术前空腹血糖、糖尿病病程等)及术前最佳矫正视力(best corrected visual acuity,BCVA)、眼压(intraocular pressure,IOP)、眼底照相、光学相干断层扫描(optical coherence tomography,OCT)测得的术后黄斑中心凹厚度(central macular thickness,CMT)。术后随访半年以上,观察并分析两组PDR患者的手术情况(如平均手术时间、术中出血、医源性裂孔发生率、硅油填充率等),术后每月BCVA、IOP、CMT等临床指标及随访期间严重眼部、全身并发症的发生率。结果:两组PDR患者手术情况比较:试验组患者的平均手术时间、术中严重出血率均少于对照组,分别是(75.64±18.73)min vs(95.36±14.74)min,14.3%vs 58.3%,且P0.05,差异具有统计学意义。术中发生医源性裂孔眼数,试验组3眼(21.4%),对照组5眼(41.7%)。术中需使用硅油填充玻璃体腔眼数,试验组4眼(28.6%),对照组8眼(66.7%)。术后因复发玻璃体积血及视网膜脱离行2次手术眼数,试验组1眼(7.1%),对照组2眼(16.7%)。试验组与对照组患者术前黄斑中心凹厚度分别为(441.92±146.92)μm、(452.23±159.62)μm,差异无统计学意义。术后4mo时黄斑中心凹厚度分别为(214.91±30.15)μm、(318.92±156.17)μm,P0.05,差异具有统计学意义。试验组与对照组患者术前最佳矫正视力分别为(20.65±26.53)、(22.29±21.78),差异无统计学意义。术后4mo时最佳矫正视力分别为(56.25±22.90)、(38.57±24.72),P0.05,差异具有统计学意义。试验组患者行康柏西普玻璃体腔内注射后,有1例出现一过性眼压升高,眼压为27mmHg,未予特殊处理,于次日恢复至正常范围。两组PDR患者治疗随访期内均未发生严重全身并发症。结论:对于增殖性糖尿病视网膜病变的患者,行玻璃体切除术前于玻璃体腔内注射康柏西普0.5mg/0.05ml,可以有效的促进眼内新生血管消退,大大减少术中出血,缩短玻璃体切除术手术时间,并降低医源性裂孔的发生率及硅油填充率,易化手术操作,同时可使患者黄斑水肿减轻,提高患者的最佳矫正视力。
[Abstract]:Objective: to compare the effects of single transciliary flat three-channel three-channel vitrectomy (PPV) with intravitreal injection of Compactopril and 23G vitrectomy on proliferative diabetic retinopathy (PDR) in patients with proliferative diabetic retinopathy.The effect of operation and clinical effect.Methods: retrospective analysis of cases.Twenty-three patients (26 eyes) with PDR were randomly selected from 2014-12 / 2015-12.They were randomly divided into two groups: control group (n = 11, 12 eyes) and experimental group (n = 12, n = 14).After admission, Comborsup 0.5 mg / 0. 05 ml was injected into the vitreous cavity, and 23 G vitrectomy was performed 6-8 days after the injection.The basic preoperative conditions (such as gender, age, preoperative fasting blood glucose, course of diabetes, etc.), the best corrected visual acuity and intraocular pressure IOP, fundus photography were recorded in the two groups of patients with PDR.The thickness of the central foveal fovea of macula was measured by optical coherence tomography (Oct) and central macular thicknessen (CMT).Two groups of patients with PDR were followed up for more than half a year. The operation time, intraoperative bleeding, iatrogenic hole rate, silicone oil filling rate and so on were observed and analyzed.Incidence of systemic complications.Results: the average operation time and severe bleeding rate in the trial group were lower than those in the control group, which were 75.64 卤18.73)min vs(95.36 卤14.74 min 14.3 vs 58.3 min, and the difference was statistically significant (P 0.05).The number of iatrogenic holes occurred in the treatment group (3 eyes) and the control group (5 eyes).The number of vitreous cavity eyes filled with silicone oil was 28.6 eyes in the test group and 66.7 eyes in the control group.The number of eyes with recurrent vitreous hemorrhage and retinal detachment was 7. 1 in the experimental group and 16. 7 in the control group.The thickness of macular fovea was 441.92 卤146.92 渭 m in the experimental group and 452.23 卤159.62 渭 m in the control group, respectively. There was no significant difference between the two groups.The thickness of macular fovea was 318.92 卤156.17 渭 m after 4mo, and the thickness of fovea was 214.91 卤30.15 渭 m (P 0.05).The preoperative best corrected visual acuity (BCVA) in the test group and the control group was 20.65 卤26.53 and 22.29 卤21.78, respectively. There was no significant difference between the two groups.The best corrected visual acuity after 4mo was 56.25 卤22.90 and 38.57 卤24.72, respectively. The difference was statistically significant.In the test group, one patient who received intravitreal injection of Comborsup showed a transient elevation of intraocular pressure (IOP) of 27mm Hg, which was recovered to normal range on the next day without special treatment.There were no severe systemic complications in the two groups of PDR patients during the follow-up period.Conclusion: for patients with proliferative diabetic retinopathy, intravitreous injection of Compactopril 0.5 mg / 0.05 ml before vitrectomy can effectively promote intraocular neovascularization and reduce intraoperative bleeding.Shortening the time of vitrectomy, reducing the incidence of iatrogenic hole and silicone oil filling rate, facilitating the operation, at the same time, can reduce the macular edema of patients and improve the best corrected visual acuity of patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6;R587.2

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