摘要
目的 探究糖明组方加减治疗与康柏西普玻璃体腔注射治疗硅油取出术后糖尿病性黄斑水肿的疗效,并观察患者视力及眼底血流情况.方法 前瞻性选取2022年3月至2023年3月在河北省沧州中西医结合医院接受糖尿病性视网膜病变引起牵拉性视网膜脱离行过玻璃体切除手术的患者,术中均给予硅油填充,并于3个月后取出,对患者进行随访,将术后发生黄斑水肿的107例患者作为研究对象.按照随机数字表法将其分组:对照组(n=53)和试验组(n=54).对照组使用康柏西普治疗,试验组使用糖明组方加减联合康柏西普治疗.比较两组的临床疗效,治疗前、治疗后1、2、3个月的视力[最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)],治疗前、治疗后3个月的眼底血流[视网膜浅层毛细血管丛(SCP)、深层毛细血管(DCP)血管密度及黄斑中心凹无血管区(FAZ)面积]差异,并记录患者的并发症发生情况.结果 试验组患者的治疗有效率为96.30％,高于对照组(83.02％),差异有统计学意义(P＜0.05).治疗后1、2、3个月,两组的BCVA均较治疗前升高,CMT均较治疗前降低,且试验组的BCVA分别为0.41±0.05、0.42±0.06、0.44±0.05,均高于对照组(0.26±0.06、0.31±0.08、0.33±0.06),CMT 分别为(311.05±56.15)、(291.23±33.46)、(281.46±52.45)μm,均低于对照组[(400.26±60.12)、(399.45±67.45)、(377.15±52.15)μm],差异均有统计学意义(P＜0.05).治疗后3个月与治疗前比较、两组患者的SCP、DCP血管密度及FAZ比较,差异均无统计学意义(P＞0.05).试验组患者结膜出血、玻璃体混浊、高眼压等总并发症发生率为3.70％,低于对照组(15.09％),差异有统计学意义(P＜0.05).结论 糖明组方加减联合康柏西普玻璃体腔注射方案治疗硅油取出术后糖尿病性黄斑水肿的临床效果优于单独使用康柏西普,且具有更低的并发症风险.
Abstract
Objective To explore the curative effect of modified Tangming prescription and conbercept intravitreal injection in the treat-ment of diabetic macular edema after silicone oil removal,and to observe the vision and fundus blood flow.Methods Prospectively selected pa-tients who underwent vitrectomy for traction retinal detachment caused by diabetic retinopathy in Cangzhou Hospital of Integrated Traditional Chi-nese and Western Medicine in Hebei Province from March 2022 to March 2023.Silicone oil was filled during the operation and removed after 3 months.The patients were followed up,and 107 patients with macular edema after operation were taken as the research objects.According to the random number table method,they were divided into the control group(n=53)and the experimental group(n=54).The control group was treated with conbercept intravitreal injection,and the experimental group was treated with Tangming prescription combined with conbercept intravit-real injection.The clinical efficacy,vision[best corrected visual acuity(BCVA),central macular retinal thickness(CMT)]before treatment,1 month,2 months and 3 months after treatment,the fundus blood flow[vascular density of superficial capillary plexus(SCP),deep capillary plex-us(DCP),and the area of macular foveal avascular zone(FAZ)]before treatment and 3 months after treatment were compared between the two groups,and the occurrence of complications in patients was recorded.Results The effective rate of treatment in the experimental group was 96.30％,which was higher than that in the control group(83.02％),and the difference was statistically significant(P＜0.05).At 1,2 and 3 months after treatment,compared with those before treatment,the BCVA of the two groups increased and the CMT decreased.The BCVA of the experimental group was 0.41±0.05,0.42±0.06 and 0.44±0.05,respectively,which were higher than those of the control group(0.26±0.06,0.31±0.08 and 0.33±0.06),and the CMT was(311.05±56.15),(291.23±33.46)and(281.46±52.45)μm,respectively,which were lower than those of the control group[(400.26±60.12),(399.45±67.45),(377.15±52.15)pm],the differences were statistically significant(P＜0.05).There were no statistically significant differences in SCP,DCP vascular density and FAZ between the two groups at 3 months after treatment and before treatment,and between the two groups at 3 months after treatment(P＞0.05).The incidence of total complica-tions such as conjunctival hemorrhage,vitreous opacity and high intraocular pressure in the experimental group was 3.70％,which was lower than that in the control group(15.09％),and the difference was statistically significant(P＜0.05).Conclusion The clinical effect of modified Tangming prescription combined with conbercept intravitreal injection in the treatment of diabetic macular edema after silicone oil removal is better than that of conbercept alone,and has a lower risk of complications.
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