雷珠单抗治疗玻璃体切除术后糖尿病黄斑水肿的疗效观察

发布时间：2018-04-19 20:52

  本文选题：光学相干断层成像 + 糖尿病黄斑水肿　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:既往研究报道,行玻璃体切除手术后,未注入硅油的眼内药物分布及清除速率发生变化,目前关于玻璃体腔内注射血管内皮生长因子(vascular endothelial growth factor,VEGF)抑制剂治疗玻璃体切除术后糖尿病黄斑水肿(diabetic macular edema,DME)的研究较少。本次研究的主要目的是观察并分析玻璃体腔注射雷珠单抗治疗玻璃体切除术后DME的临床疗效。方法:选取既往接受玻璃体切除手术,于2014年12月至2016年7月期间就诊于大医一院眼科确诊为DME,并接受玻璃体腔注射雷珠单抗治疗的患眼。记录并整理入选患者的一般情况及专科情况。其中一般情况,如性别、年龄、糖尿病(diabetes mellitus,DM)类型及病程、既往接受玻璃体切除手术的时间及病因、是否接受过白内障手术治疗、是否接受过眼内激光治疗以及激光治疗的类型。专科情况包括最佳矫正视力(best corrected visual acuity,BCVA)、裂隙灯眼前节检查结果、眼底检查结果、眼压(intraocular pressure,IOP),以及应用光学相干断层成像(optical coherence tomography,OCT)测得的患者黄斑中心凹视网膜厚度(central macular thickness,CMT)。所有患者均给予玻璃体腔注射雷珠单抗0.5mg/0.05ml,每月1次,连续注射3次。测量并记录患者术前及连续治疗3个月后随访时的BCVA、CMT及IOP。应用SPSS17.0软件进行统计学分析,分析前BCVA换算成logMAR值,治疗前及治疗后BCVA、CMT和IOP的比较应用配对样本t检验,P0.05认为差异有统计学意义。结果:本次研究共收集玻璃体切除术后DME患者28例(33眼),每月1次,连续注射3次。33眼治疗前平均IOP为(17.45±2.77)mmHg,治疗后平均IOP为(17.70±2.80)mmHg,治疗前后差异无统计学意义(P = 0.45)。治疗前BCVA(logMAR)为 0.22～1.30,平均为 0.58±0.27;治疗后 BCVA 为 0.10～1.30,平均为0.55±0.28,较术前平均提高0.03(P = 0.52)。其中12只眼(36%)视力提高或降低0.1,视力较术前无明显变化;9只眼(27%)视力降低≥0.1,其中3只眼(9%)视力降低≥0.3;12只眼(36%)视力提高≥0.1,其中3只眼(9%)的视力提高≥0.3。注药前 CMT 为(290-450)um,平均为(371.39±76.58)um;治疗后CMT为(234-410)um,平均为(320.09±77.34)um,CMT较术前平均下降14%(P = 0.01)。16只眼(48.5%)黄斑水肿吸收,OCT显示视网膜内和视网膜下无水肿增厚区。17只眼(51.5%)治疗后OCT测量值表明仍存在黄斑水肿,其中6只眼(35%)有轻微的旁中心凹视网膜或视网膜前纤维增殖。在黄斑水肿吸收的16只眼中,仅2眼(13%)存在旁中心凹视网膜或视网膜前纤维增殖。部分患者尽管CMT较术前显著降低,但视力无明显改善。结论:玻璃体腔注射雷珠单抗能有效改善玻璃体切除术后的糖尿病黄斑水肿,降低黄斑中心凹视网膜厚度(CMT)。术后患者黄斑中心凹视网膜厚度(CMT)显著下降,但最佳矫正视力(BCVA)较术前无明显提高。
[Abstract]:Objective: Previous studies have reported changes in the distribution and clearance rate of intraocular drugs without silicone oil after vitrectomy. At present, the vascular endothelial growth factor (VEGF) inhibitor is currently used to treat diabetic macular edema after vitrectomy (diabetic macular edema, DM). The main purpose of this study was to observe and analyze the clinical effect of DME after vitrectomy in the treatment of vitrectomy by intravitreal injection of rezumumab. Methods: a previous vitrectomy was selected, and from December 2014 to July 2016, DME was diagnosed in the ophthalmology department of the great medical hospital, and the vitreous intravitre injection of ray beads was accepted. The general situation and special situation of the patients were recorded and collate. General conditions, such as sex, age, type and course of diabetes (diabetes mellitus, DM), the time and cause of previous vitrectomy, whether to receive cataract hand surgery, or not, have received intraocular laser treatment and laser treatment. The type of treatment included the best corrected visual acuity (best corrected visual acuity, BCVA), the results of the slit lamp anterior segment examination, the results of the fundus examination, the intraocular pressure (intraocular pressure, IOP), and the macular macular retinal thickness measured by the application of optical coherence tomography (optical coherence tomography, OCT). Thickness, CMT). All patients were given intravitreal injection of reelzumumab 0.5mg/0.05ml, 1 times a month, 3 consecutive injections. Measured and recorded the patients' BCVA, CMT and IOP. with SPSS17.0 software for 3 months before and after 3 months of continuous treatment. The former BCVA was converted into logMAR values, BCVA, CMT, and IOP. Compared with paired sample t test, P0.05 thought the difference was statistically significant. Results: 28 cases (33 eyes) of DME patients after vitrectomy were collected, 1 times a month, and the average IOP was (17.45 + 2.77) mmHg before continuous injection of 3.33 eyes, and the average IOP after treatment was (17.70 + 2.80) mmHg, and there was no statistical difference before and after treatment (P = 0.45). Before treatment, BCVA (logMAR) was 0.22 ~ 1.30, the average was 0.58 + 0.27, and BCVA was 0.10 ~ 1.30 after treatment, the average was 0.55 + 0.28, compared with the preoperative average of 0.03 (P = 0.52). Among them, the visual acuity of 12 eyes (36%) was improved or reduced, and the visual acuity decreased more than before the operation. ) improvement of visual acuity was more than 0.1, of which 3 eyes (9%) had improved visual acuity (290-450) um before 0.3. injection (290-450) um, average (371.39 + 76.58) um, CMT was (234-410) um, average (320.09 + 77.34) um, CMT compared with 14% (P = 0.01).16 (P = 0.01).16 only (48.5%) macular edema absorption, OCT display of retinal and subretinal edema thickening region.17. OCT measurements showed that there was still macular edema after treatment (51.5%), of which 6 eyes (35%) had a slight paracert retina or retinal preretinal fiber proliferation. In 16 eyes of macular edema, only 2 eyes (13%) had paracerpic retina or retinal preretinal fibers. Although CMT was significantly lower than before, no visual acuity was found in some patients. Conclusion: the intravitreal injection of amozumab can effectively improve diabetic macular edema after vitrectomy and decrease the retinal thickness of the macular fovea (CMT). The retinal thickness of the macular fovea (CMT) in the patients after surgery is significantly decreased, but the best corrected visual acuity (BCVA) is not significantly higher than that before operation.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R779.6
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