摘要目的 观察玻璃体腔注射雷珠单抗(IVR)、全视网膜激光光凝(PRP)对增生型糖尿病视网膜病变(PDR)玻璃体切割手术及治疗效果的影响.方法 临床确诊为PDR并行23G玻璃体切割手术治疗的60例患者78只眼纳入研究.玻璃体切割手术前行IVR治疗者22例28只眼(A组),行PRP治疗者18例20只眼(B组),未行IVR、PRP治疗者20例30只眼(C组).对比观察3组患者玻璃体切割手术时间、医源性裂孔、眼内填充硅油、应用电凝止血、手术后出血等情况以及手术后3个月的最佳矫正视力(BCVA).结果 A、B、C组平均手术时间分别为(67.429±11.243)、(77.762±10.435)、(106.839±20.724) min;A、B组平均手术时间均较C组缩短,差异均有统计学意义(t=8.940、5.928,P＜0.05).A、B、C组手术中应用电凝止血者分别为5、6、24只眼,A、B组手术中应用电凝止血的眼数较C组明显偏少,差异均有统计学意义(x2=19.955、10.505,P＜0.05).A、B、C组手术中填充硅油者分别为4、3、23只眼,A、B组手术中填充硅油的眼数较C组明显偏少,差异均有统计学意义(x2 =18.099、14.083,P＜0.05).A、B、C组手术中发生医源性裂孔及手术后出血的眼数比较,差异均无统计学意义(P＞0.05).手术后3个月,A、B、C组患眼平均BCVA分别为0.383±0.122、0.251士0.067、0.104士0.044;A、B组患眼平均BCVA均较C组提高,差异均有统计学意义(t=11.909、13.616,P＜0.05).结论 玻璃体切割手术前应用IVR或PRP治疗PDR可缩短手术时间,减少手术中出血及眼内填充物的使用几率,提高患眼视力.

abstractsObjective To observe the different effect of 23G vitrectomy surgery assisted with intravitreal injection of ranibizumab and pan-retina photocoagulation in severe proliferative diabetic retinopathy (PDR) treatment.Methods A total of 60 patients (78 eyes) with severe PDR diagnosed were enrolled and divided into intravitreal injection of Lucentis group (Group A,22 patients,28 eyes),pan-retina photocoagulation group (Group B,18 patients,20 eyes) and control group (Group C,20 patients,30 eyes),all of them received 23G vitreoretinal surgery.The average operation time,iatrogenic hiatus,the use of filler and electric coagulation,postoperative bleeding and best corrected visual acuity in three months were comparatively analyzed among the three groups.Results The operation time in the three group was (67.429± 11.243),(77.762± 10.435),(106.839 ± 20.724) min respectively,the differences of A vs C and B vs C were statistically significant(t=8.940,5.928;P＜0.05).Five eyes needed electric coagulation in Group A,6 eyes in Group B,and 24 eyes in Group C,the differences of A vs C and B vs C were all statistically significant (x2=19.955,10.505;P＜0.05).Four eyes used the filler in Group A,3 eyes in Group B,and 23 eyes in Group C,the differences of A vs C and B vs C were all statistically significant (x2=18.099,14.083;P＜0.05).The difference of iatrogenic hiatus and postoperative bleeding was no significance among the three groups (P＞0.05).The best corrected visual acuity of 3 months after surgery in the three group is (0.383±0.122),(0.251±0.067),(0.1044-0.044) respectively,the differences of A vs C and B vs C were all statistically significant(t=11.909,13.616;P＜0.05).Conclusion The intravitreaI injection of ranibizumab or pan-retina photocoagulation treatment before the vitrectomy surgery is very effective,both of them can shorten the operation time,reduce electric coagulation and use of filler,and improve patients' eyesight.