单纯激光与激光联合玻璃体腔内注射抗VEGF药物治疗糖尿病性视网膜病变的疗效观察

发布时间：2018-06-30 06:38

本文选题：全视网膜光凝术 + 血管内皮生长因子抑制剂　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的选取糖尿病性视网膜病变伴黄斑水肿的病人,分组治疗,观察单纯全视网膜光凝术和全视网膜光凝联合玻璃体腔内注射血管内皮生长因子抑制剂的临床疗效及安全性。方法选择自2015年9月至2016年7月就诊于我院眼科的非增殖性糖尿病视网膜病变(III期)或增殖性糖尿病视网膜病变(IV期)且合并局灶性或弥漫性黄斑水肿的患者,共41例61只眼,其中男性患者14例,女性患者27例,平均年龄54.21±9.61岁。激光组24人38只眼,男10例,女14例,平均年龄53.00±8.75岁,每周1次在门诊行视网膜光凝术,共3-4次,方可完成全视网膜光凝。联合组17人23只眼,男4例,女13例,平均年龄56.13±10.88岁,每月1次共2次在手术室内进行玻璃体腔注射抗VEGF药物(21只眼注射康柏西普,2只眼注射雷珠单抗)。首次注药后1周,开始门诊分期完成PRP,方法同激光组。利用标准对数视力表随访治疗前、治疗后第1周、第1个月,第3个月时最佳矫正视力,利用光学相干断层扫描仪随访两组患者治疗前、治疗后第1周、第1个月,第3个月时的黄斑区体积和黄斑区视网膜厚度的改变。将这些数据输入统计软件SPSS17.0进行分析,观察两组数据的统计学结果,评估两者的临床疗效。结果激光组患者在完成全视网膜光凝术后,视力相对稳定,无明显提高或下降(P0.05),黄斑区平均视网膜厚度和黄斑区总体积在术后1周、术后1个月、术后3个月较术前均有不同程度增加(P0.05),且术后1个月时最显著。术后3个月时数据又有所回落,但仍稍高于术前。黄斑区中心视网膜厚度在术后1周、1月较术前有所增加,差异具有统计学意义(P0.05),术后3个月时基本恢复到术前水平(P0.05)。联合组患者视力较术前有相应提高,黄斑区视网膜平均厚度、中心厚度和总体积在术后各时间段较术前有不同程度下降,差异均有统计学意义(P0.05)。结论(1)全视网膜光凝术可以防止患眼病情恶化,视力下降,是治疗糖尿病性视网膜病变经典而有效的方式。短期内可能会加重黄斑水肿,但随时间推移会有所改善,可恢复至术前水平。(2)玻璃体腔注射血管内皮生长因子抑制剂联合全视网膜激光光凝治疗糖尿病性视网膜病变疗效显著,可改善黄斑水肿,提高患者视力,且较为安全。(3)光学相干断层扫描仪具有非接触、非侵入性,高分辨率及定量分析等优点,可以客观显示眼底黄斑区视网膜厚度与体积的变化,适用于糖尿病视网膜病变患者的病情随访。
[Abstract]:Objective to observe the clinical efficacy and safety of total retinal photocoagulation and intravitreal injection of vascular endothelial growth factor inhibitor in patients with diabetic retinopathy with macular edema. Methods from September 2015 to July 2016, 41 cases (61 eyes) of non-proliferative diabetic retinopathy (stage III) or proliferative diabetic retinopathy (stage IV) with focal or diffuse macular edema were selected. There were 14 males and 27 females with an average age of 54.21 卤9.61 years. In the laser group, 38 eyes (10 males and 14 females) with an average age of 53.00 卤8.75 years, underwent retinal photocoagulation once a week, 3 to 4 times a week, in order to complete the whole retinal photocoagulation. In the combined group, 23 eyes (male 4, female 13, mean age 56.13 卤10.88) were treated with intravitreal intravitreous injection of anti-VEGF drugs (21 eyes were injected with Compactopril 2 eyes). One week after the first injection, the PRP was completed by stages in the outpatient clinic, and the same method was used in the laser group. Standard logarithmic visual acuity chart was used to follow up before treatment, 1 week, 1 month and 3 months after treatment. Optical coherence tomography was used to follow up the two groups before treatment, 1 week after treatment, 1 month after treatment. Changes of macular area volume and macular retinal thickness at 3 months. These data were input into the statistical software SPSS 17.0 to analyze and observe the statistical results of the two groups of data and evaluate the clinical efficacy of the two groups. Results in the laser group, the visual acuity was relatively stable, without significant improvement or decrease (P0.05). The mean retinal thickness and the total volume of macular area in the laser group were 1 week after operation and 1 month after operation. Three months after operation were increased in varying degrees compared with those before operation (P0.05), and the most significant at 1 month after operation. After 3 months, the data decreased, but still slightly higher than before. The central retinal thickness of macular area increased in 1 week and 1 month after operation (P0.05), and recovered to the preoperative level 3 months after operation (P0.05). The mean retinal thickness, central thickness and total volume of macular area in the combined group were significantly lower than those before the operation (P0.05). Conclusion (1) Total retinal photocoagulation is a classic and effective method for the treatment of diabetic retinopathy. Macular edema may be aggravated in the short term, but it will be improved over time and can recover to the preoperative level. (2) the effect of intravitreal injection of vascular endothelial growth factor inhibitor combined with whole retinal laser photocoagulation on diabetic retinopathy is remarkable. It can improve macular edema and improve the visual acuity of the patients. (3) Optical coherence tomography has the advantages of non-contact, non-invasive, high resolution and quantitative analysis, and can objectively display the changes of retinal thickness and volume in the macular area. It is suitable for the follow-up of diabetic retinopathy.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R779.63

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