雷珠单抗联合全视网膜激光光凝治疗重度非增生型糖尿病视网膜病变的疗效观察

发布时间：2018-05-02 07:46

本文选题：雷珠单抗 + 全视网膜光凝　；参考：《眼科新进展》2017年08期

【摘要】：目的探讨雷珠单抗玻璃体内注射联合全视网膜激光光凝治疗重度非增生型糖尿病视网膜病变的临床疗效。方法将本院2014年7月至2016年6月收治的重度非增生型糖尿病视网膜病变患者64例(90眼),随机分为两组:对照组32例(44眼)单纯采用全视网膜激光光凝(panretinal photocoagulation,PRP)治疗,观察组32例(46眼)采用玻璃体内注射雷珠单抗联合PRP治疗,观察两组治疗前,治疗后1个月、3个月、6个月的最佳矫正视力(best corrected visual acuity,BCVA)、眼底、眼底荧光血管造影(fundus fluorescein angiography,FFA)、黄斑区视网膜神经上皮层厚度和黄斑区6 mm直径神经上皮总体容积,记录并计算治疗中的激光能量、光斑数和能量密度,对上述数据进行比较。结果对照组和观察组患者治疗后1个月、3个月、6个月时BCVA均优于治疗前(均为P0.05),并且观察组患者治疗后1个月、3个月、6个月时BCVA均优于对照组(均为P0.05);对照组治疗后6个月时BCVA与治疗后3个月比较,差异无统计学意义(P0.05),其他时间点比较差异均有统计学意义(均为P0.05);观察组治疗后各时间点比较差异均有统计学意义(均为P0.05)。黄斑区视网膜神经上皮层平均厚度和黄斑区6 mm直径神经上皮总体容积的对比中,对照组和观察组治疗前后比较、治疗后两组中不同时间点之间比较差异均有统计学意义(均为P0.05)。并且观察组患者治疗后1个月、3个月、6个月时黄斑区视网膜神经上皮层厚度、黄斑区6 mm直径神经上皮总体容积均优于对照组(均为P0.05)。观察组在激光能量、光斑数和能量密度均显著低于对照组(均为P0.05)。结论玻璃体内注射雷珠单抗联合PRP治疗重度非增生型糖尿病视网膜病变,利用较少的激光能量,可在较短时间内加快视网膜新生血管的消退、减轻黄斑水肿并改善患者的视功能,其疗效优于单纯应用PRP治疗,值得临床推广。
[Abstract]:Objective to investigate the clinical effect of intravitreous injection of Leizhu monoclonal antibody combined with total retinal laser photocoagulation in the treatment of severe nonproliferative diabetic retinopathy. Methods Sixty-four patients with severe non-proliferative diabetic retinopathy from July 2014 to June 2016 were randomly divided into two groups: the control group (32 cases, 44 eyes) and the control group (32 cases, 44 eyes) were treated with panretinal photocoagulation alone (PRP). 32 cases (46 eyes) in the observation group were treated with intravitreous injection of Lei Zhu McAb combined with PRP. The best corrected visual acuity before, 1 month, 3 months and 6 months after treatment were observed in both groups. Fundus fluorescein angiography, the thickness of retinal neuroepithelial layer in macular area and the total volume of neuroepithelium in macular area 6 mm in diameter were recorded and calculated. The laser energy, the number of spots and the energy density were recorded and calculated, and the above data were compared. Results the BCVA of the control group and the observation group was better than that of the control group at 1 month, 3 months and 6 months after treatment (P 0.05), and the BCVA of the observation group was better than that of the control group at 1 month, 3 months and 6 months after treatment. BCVA was compared at 6 months after treatment with that at 3 months after treatment. There was no statistical difference (P 0.05), but there was significant difference in other time points (all P 0.05), and there was significant difference in observation group (P 0.05) after treatment. The mean thickness of retinal nerve epithelium in macular area and the total volume of 6 mm diameter neuroepithelium in macular area were compared between the control group and the observation group before and after treatment. After treatment, there were significant differences between the two groups at different time points (P 0.05). The retinal neuroepithelial layer thickness of macular area and the total volume of 6 mm diameter neuroepithelium of macular area in the observation group were better than those in the control group at 1 month, 3 months and 6 months after treatment (all P 0.05). The laser energy, spot number and energy density in the observation group were significantly lower than those in the control group (P 0.05). Conclusion intravitreous injection of Lei Zhu McAb combined with PRP in the treatment of severe non-proliferative diabetic retinopathy can accelerate retinal neovascularization in a short time by using less laser energy. The curative effect of reducing macular edema and improving the visual function of patients is better than that of PRP alone, and it is worth popularizing clinically.
【作者单位】：福建省宁德市闽东医院眼科;福建省宁德市闽东医院消化内科;
【分类号】：R587.2;R779.63

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