糖尿病性黄斑水肿联合治疗效果观察
Observation on the clinical efficacy of combined therapy for the treatment of diabetic macular edema
李艳丽 1李秋明 2董淑倩 2董洪涛 2郭洁 2朱伟萍 3马耀光3
作者信息
- 1. 455000河南,濮阳市安阳地区医院眼科
- 2. 450052郑州,郑州大学第一附属医院眼科
- 3. 471000洛阳,洛宁县人民医院眼科
- 折叠
摘要
目的 观察玻璃体内注射雷珠单抗联合视网膜激光光凝治疗糖尿病性黄斑水肿(DME)的临床疗效.方法 选取2013年11月至2014年10月在郑州大学第一附属医院眼科就诊的DME患者60例(60眼),随机分为联合治疗组和对照组各30例;联合治疗组先行雷珠单抗玻璃体内注射,1周后再行标准的黄斑区格栅状光凝;对照组单纯行雷珠单抗玻璃体内注射治疗.视力检查采用标准对数视力表进行,并将结果转换成最小分辨角对数(logMAR)视力记录.比较两组治疗后1、3、6个月的最佳矫正视力(BCVA)和黄斑中心区视网膜厚度(CMT)的变化.联合治疗组治疗前平均BCVA为0.75±0.32;对照组为0.74 ±0.29,两组差异无统计学意义(t=0.20,P=0.83).联合治疗组治疗前平均CMT为(486.87 ±92.44) μm;对照组平均CMT为(487.13 ±86.519) μm,两组在治疗前的CMT比较差异无统计学意义(t=1.247,P=0.089).结果 对照组治疗后1、3、6个月的BCVA分别为(0.41 ±4.10)、(0.40 ±0.85)、(0.36±9.85);CMT分别为(289.54±104.23)μm、(310.36±98.48) μm、(398.88±93.31) μm;联合治疗组治疗后1、3、6个月的BCVA分别为(0.44±1.60)、(0.43±1.73)、(0.44 ±2.36);CMT分另别为(273.53±103.36)μm、(275.21 ±92.14) μm、(274.65±93.21) μm.两组在治疗后1、3、6个月的BCVA比较差异均有统计学意义(t=2.16,P=0.04;t2.34,P=0.02;t =4.25,P=0.00);两组在治疗后1、3、6个月的CMT比较差异均有统计学意义(t=2.114,P=0.021;=2.352,P=0.015;t =2.534,P=0.008);与治疗前比,两组BCVA均明显提高(P＜0.05)、CMT均呈现快速下降(P＜0.05).后期对照组的BCVA略呈下降趋势,CMT略呈上升趋势,而联合组则基本保持稳定.结论 雷珠单抗玻璃体内注射联合黄斑格栅状光凝与单纯雷珠单抗玻璃体内注射均能提高DME患者的视力,减轻其黄斑水肿,联合治疗的疗效更为稳定.
Abstract
Objective To observe the clinical efficacy of intravitreal Ranibizumab combined with macular grid photocoagulation for treatment of diabetic macular edema (DME).Methods Sixty eyes of 60 patients with DME in the First Affiliated Hospital of Zhengzhou University from November 2013 to October 2014.They were randomly divided into 2 groups:the combined therapy group of 30 eyes and the control group of 30 eyes.The patients in combined therapy group received intravitreal Ranibizumab injection,and then combined with standard macular grid photocoagulation one week later.The patients in the control group received intravitreal Ranibizumab only.The visual acuity was examined with standard chart.The vision results converted into logarithmic of the minimum angle resolution (logMAR) to record.The changes of the logMAR of best corrected visual acuity (BCVA) and central macular thickness (CMT) before and 1,3,6 months after the treatment were compared.The average BCVA of the combined therapy group before treatment was 0.75 ± 0.32 and the average BCVA of control group was 0.74 ± 0.29.There was no statistically significant difference (t =0.20,P =0.83) in BCVA between the two groups.The average CMT is (486.87 ± 92.44) μm in the combined therapy group and(487.13 ± 86.519)μm in the control group before treatment.There was no statistically significant difference (t =1.247,P =0.089) in the CMT of two groups.Results At 1,3,6 months after the treatment,the BCVA of patients in control group were (0.41 ± 4.10),(0.40 ± 0.85) and(0.36 ± 9.85) and the CMT were (273.53 ± 103.36) μm,(275.21 ± 92.14) μm and (274.65 ± 93.21)μm,respectively.Howerer,in combined therapy group,the BCVA were (0.44 ± 1.60),(0.43 ± 1.73) and (0.44 ± 2.36) and the CMT were (273.53 ± 103.36) μm,(275.21 ± 92.14) μm and (274.65 ± 93.21) μm respectively.There were statistically significant differences (t =2.16,P =0.04;t =2.34,P =0.02;t =4.25,P=0.00)in the BCVA and in the CMT (t =2.114,P =0.021;t =2.352,P =0.015;t =2.534,P =0.008)at 1,3,6 months after the treatment between the two groups.The BCVA in both two groups were significantly improved compared with that of preoperative (P ＜ 0.05).The CMT decreased rapidly after the treatment(P ＜ 0.05).During the follow-up,the BCVA presented declining trend and the CMT was on the rise slowly in the control group.The BCVA and CMT in combined therapy group remained stable.Conclusion Intravitreal Ranibizumab injection combined with macular grid photocoagulation and simple Ranibizumab intravitreal injection can improve the vision and reduce macular edema in DME patients and the therapeutic efficacy of the combined group is more stable than the control group.
关键词
黄斑水肿,糖尿病性/雷珠单抗,玻璃体内注射/格栅状光凝,黄斑Key words
Macular edema,diabetic/Ranibizumab,intravitreal injection/Grid photocoagulation,macular引用本文复制引用
出版年
2016
NETL
NSTL
维普
万方数据