玻璃体内注射雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿的临床疗效及安全性评价

doi:10.13481/j.1671-587x.20150339

吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (03): 643-647.doi: 10.13481/j.1671-587x.20150339

玻璃体内注射雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿的临床疗效及安全性评价

李沭岩¹, 刘莎莎², 刘丽华¹, 李婧¹

1. 上海市杨浦区中心医院眼科, 上海 200090;
2. 大连医科大学附属第一医院眼科, 辽宁大连 116011

收稿日期:2014-12-08 发布日期:2015-08-01
通讯作者: 刘莎莎,主治医师(Tel:0411-84394278,E-mail:dlliushasha@163.com) E-mail:dlliushasha@163.com
作者简介:李沭岩(1980-),女,上海市人,主治医师,医学硕士,主要从事眼底病的临床治疗方面的研究。
基金资助:
上海市卫生局科研基金资助课题(20134419)

Evaluation on efficacy and safety of combination treatment with intravitreal injection of ranibizumab and laser photocoagulation for diabetic macular edema

LI Shuyan¹, LIU Shasha², LIU Lihua¹, LI Jing¹

1. Department of Ophthalmology, Central Hospital of Yangpu District, Shanghai City, Shanghai 200090, China;
2. Department of Ophthalmology, First Affiliated Hospital, Dalian Medical University, Dalian 116011, China

Received:2014-12-08 Published:2015-08-01

摘要/Abstract

摘要：

目的:探讨玻璃体内注射雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿(DME)的临床疗效及安全性,阐明这种联合治疗方法治疗DME的优势。方法:采用临床病例对照研究。经眼底检查、眼底荧光血管造影(FFA)及黄斑光学相干断层扫描(OCT)检查确诊为重度非增殖性糖尿病视网膜病变(DR)和增殖性DR伴黄斑水肿的71例(85眼)患者被随机分为联合治疗组(42眼行玻璃体内注射雷珠单抗联合视网膜光凝治疗)和单纯光凝组(43眼仅行视网膜光凝治疗)。观察治疗前后患者最佳矫正视力(BCVA)、黄斑中心凹处视网膜厚度(CMT)和眼压的变化,并进行比较和统计分析。结果:联合治疗组治疗后患者BCVA较术前明显提高(P<0.05),单纯光凝组治疗后患者BCVA与治疗前比较差异无统计学意义(P>0.05),光凝治疗后1、3、6个月联合治疗组患者BCVA优于单纯光凝组(P<0.05)。与治疗前比较,光凝治疗后1、3、6个月时2组患者CMT均降低,且各阶段联合治疗组患者CMT均值小于单纯光凝组,差异有统计学意义(P<0.05)。治疗过程中2组患者均未发生青光眼、白内障、玻璃体积血、视网膜脱离、脉络膜脱离和感染性眼内炎等眼部及全身严重并发症。结论:视网膜激光光凝联合玻璃体内注射雷珠单抗治疗DR并发黄斑水肿可以更快速有效地减轻黄斑水肿并改善视力,且并发症少。

关键词: 雷珠单抗, 糖尿病视网膜病变, 黄斑水肿, 全视网膜光凝, 黄斑区格栅样光凝

Abstract:

Objective To discuss the efficacy and safety of intravitreal injection of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema (DME), and to explain the advantages of this combination treatment method in treating DME. Methods 71 patients (85 eyes) with macular edema due to diabetic retinopathy(DR) were randomly divided into combination treatment group (42 eyes received intravitreal injections of ranibizumab combined with laser photocoagulation treatment) and photocoagulation group (43 eyes received laser photocoagulation treatment only).The changes of the best corrected visual acuity (BCVA), the fovea centralis thickness (CMT), and the intraocular pressure before and after treatment were observed and analyzed. Results The BCVA of the patients in combination treatment group was improved after treatment than before (P<0.05), but there was no difference of BCVA in photocoagulation group before and after treatment(P>0.05).The BCVA improvement in combination treatment group was statistically more significant (P<0.05) compared with photocoagulation group in 1 month, 3 months and 6 months after laser photocoagulation treatment.Compared with before treatment, the CMT of the patients in two groups in 1 month, 3 months, 6 months after laser photocoagulation treatment were reduced.At each stage, the CMT of the patients in combination treatment group were lower than those in photocoagulation group (P<0.05).No complications of glaucoma, cataract, vitreous hemorrhage, retinal detachment, choroidal detachment, endophthalmitis and no systemic complications were observed in all patients. Conclusion For the patients with DME, the combination treatment with intravitreal injection of ranibizumab and laser photocoagulation has a more quickly and better therapeutic effect than the sole laser photocoagulation treatment in reducing the macular edema and improving the BCVA, also has less complication.

Key words: ranibizumab, diabetic retinopathy, macular edema, panretinal photocoagulation, macular laser grid

中图分类号:

R774.5

李沭岩, 刘莎莎, 刘丽华, 李婧. 玻璃体内注射雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿的临床疗效及安全性评价[J]. 吉林大学学报(医学版), 2015, 41(03): 643-647.

LI Shuyan, LIU Shasha, LIU Lihua, LI Jing. Evaluation on efficacy and safety of combination treatment with intravitreal injection of ranibizumab and laser photocoagulation for diabetic macular edema[J]. Journal of Jilin University Medicine Edition, 2015, 41(03): 643-647.

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玻璃体内注射雷珠单抗联合视网膜光凝治疗糖尿病性黄斑水肿的临床疗效及安全性评价

Evaluation on efficacy and safety of combination treatment with intravitreal injection of ranibizumab and laser photocoagulation for diabetic macular edema

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