激光联合雷珠单抗治疗增殖型糖尿病视网膜病变

发布时间：2018-11-17 20:07

【摘要】：目的:回顾分析对于增殖型糖尿病视网膜病变(proliterative diabetic retinopathy,PDR)患者进行激光联合或者不联合雷珠单抗治疗的临床效果。方法:收集整理并分析2009-08/2015-02间我院33例66眼仅有新生血管(包括视乳头或者视网膜上)不伴有视网膜纤维增殖膜以及玻璃体积血的PDR病历及随访资料。治疗方法一:全视网膜激光光凝在1mo内分次进行完成;治疗方法二:先玻璃体内注射雷珠单抗,5d后进行激光,1mo内完成全视网膜光凝。随访患者治疗前、激光治疗后1、2、3wk,1、2、3mo的视力、眼压、眼底、眼B超等检查。结果:在33例66眼患者中,男16例32眼,女17例34眼,年龄23~65岁。观察在激光期间以及之后3mo随访中,视力以及发生玻璃体积血和黄斑水肿的情况。治疗一组的患者18例36眼,治疗前视力低于0.3者10眼(28%),0.3~0.6者20眼(56%),0.8~1.0者6眼(17%)。治疗期间发生玻璃体积血22眼(61%);发生黄斑水肿或者加重10眼(28%)。治疗二组的患者15例30眼治疗前视力低于0.3者9眼(30%),0.3~0.6者15眼(50%),0.8~1.0者6眼(20%)。发生玻璃体积血6眼(20%);发生黄斑水肿或者加重4眼(13%)。两组间治疗前视力等基本情况差别无明显统计学意义(P0.05),在两种不同治疗方式后,两组间最后视力的差异有统计学意义(P0.05)。结论:通过在激光前玻璃体内注射雷珠单抗的治疗,可以明显降低PDR患者的玻璃体积血以及黄斑水肿等并发症的发生。眼内雷珠单抗联合激光是治疗仅有新生血管不伴有纤维增殖膜以及玻璃体积血的PDR有效手段,可减少玻璃体积血和黄斑水肿等严重并发症的发生,降低对患者视功能的损伤的同时,增强患者治疗的依从性。
[Abstract]:Objective: to retrospectively analyze the clinical effect of laser combined with or without Rayzumab in patients with proliferative diabetic retinopathy (proliterative diabetic retinopathy,PDR). Methods: the PDR records and follow-up data of 66 eyes of 33 patients (66 eyes) with only new vessels (including optic papilla or retinal) without retinal fiber proliferative membrane and vitreous hemorrhage in 2009-08 / 2015-02 were collected and analyzed. Treatment method 1: the whole retinal laser photocoagulation was completed in 1mo, the second method was: first, intravitreous injection of Lei Zhu McAb, 5 days after laser, 1mo complete the whole retina photocoagulation. The visual acuity, intraocular pressure, fundus and ultrasound were examined before and after laser treatment. Results: of the 33 cases, 32 eyes were male and 34 eyes were female. The age was 2365 years old. Visual acuity, vitreous hemorrhage and macular edema were observed during and after 3mo follow-up. The visual acuity of 18 patients (36 eyes) was less than 0.3 in 10 eyes (28%), 0.30.60 eyes in 20 eyes (56%) and 0.81.0 eyes in 6 eyes (17%). Vitreous hemorrhage occurred in 22 eyes (61%) and macular edema or aggravation in 10 eyes (28%). The visual acuity of 15 patients (30 eyes) before treatment was less than 0.3 in 9 eyes (30%), 0.3 + 0.6 in 15 eyes (50%) and 0.81.0 in 6 eyes (20%). Vitreous hemorrhage occurred in 6 eyes (20%), macular edema in 4 eyes (13%). There was no significant difference in visual acuity between the two groups before treatment (P0.05). After two different treatments, the difference of final visual acuity between the two groups was statistically significant (P0.05). Conclusion: vitreous hemorrhage and macular edema in PDR patients can be significantly reduced by intravitreous injection of Lei Zhu McAb. Intraocular Leizhu monoclonal antibody combined with laser is an effective method for the treatment of PDR with only neovascularization without fibroproliferative membrane and vitreous hemorrhage, which can reduce the occurrence of severe complications such as vitreous hemorrhage and macular edema. Reduce the damage to the patient's visual function, at the same time, enhance the patient's compliance with the treatment.
【作者单位】：上海中医药大学附属曙光医院眼科;复旦大学附属眼耳鼻喉科医院眼科;
【基金】：上海市中医药事业发展三年行动计划(重大研究)基金资助课题(No.ZYSNXD-CC-ZDYJ046)~~
【分类号】：R587.2;R774.1

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