中华眼外伤职业眼病杂志2024，Vol.46Issue(9) ：641-648.DOI:10.3760/cma.j.cn116022-20240312-00055

玻璃体切除术前玻璃体内注射抗血管内皮生长因子药物治疗增生型糖尿病视网膜病变的效果

Efficacy of intravitreal injection of anti-vascular endothelial growth factor drugs before pars plana vitrectomy on proliferative diabetic retinopathy

孙亚杰 赫天耕 江枫 韩寒 赵娉婷 孟祥达 孙昂 苏雯琪
中华眼外伤职业眼病杂志2024，Vol.46Issue(9) ：641-648.DOI:10.3760/cma.j.cn116022-20240312-00055
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玻璃体切除术前玻璃体内注射抗血管内皮生长因子药物治疗增生型糖尿病视网膜病变的效果

Efficacy of intravitreal injection of anti-vascular endothelial growth factor drugs before pars plana vitrectomy on proliferative diabetic retinopathy

孙亚杰 1赫天耕 2江枫 2韩寒 2赵娉婷 2孟祥达 2孙昂 2苏雯琪2
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作者信息

  • 1. 天津医科大学总医院空港医院眼科,天津 300308
  • 2. 天津医科大学总医院眼科,天津 300041
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摘要

目的 评估玻璃体切除术(PPV)术前玻璃体内注射不同类型抗血管内皮生长因子(VEGF)药物治疗增生型糖尿病视网膜病变(PDR)的临床效果.方法 前瞻随机对照研究.纳入天津医科大学总医院2019年7月至2022年12月的PDR 90例(90只眼).将患者通过随机数字表法分为3个组:雷珠单抗组(30例,30只眼)、康柏西普组(30例,30只眼)以及阿柏西普组(30例,30只眼).每组患者均初始接受玻璃体内注射相应药物的治疗,3～4 d后进行PPV手术.比较3组在术前及术后6个月的最佳矫正视力(BCVA,logMAR)、黄斑中心区厚度(CMT)及黄斑囊样水肿(CME)的发生率.结果 最终,雷珠单抗组中29例(96.7％),康柏西普组中30例(100.0％),阿柏西普组中27例(90.0％)完成随访.雷珠单抗组、康柏西普组及阿柏西普组3组患者在注药及PPV术后6个月的 BCVA 分别为 1.83±0.69、0.78±0.52,1.86±0.78、0.70±0.71,2.03±0.63、0.76±0.60,均较术前明显提高,差异有统计学意义(t=6.46、6.01、7.62,均P＜0.001),且3组间BCVA差异无统计学意义(F=0.76、0.24,P=0.470、0.787).注药前及PPV术后6个月,3组患者的CMT分别为(306.32±124.04)、(300.86±118.98),(304.86±76.35)、(271.20±102.03),(371.67±129.54)、(308.63±103.03)µm,与术前相比差异无统计学意义(t=0.17、1.43、1.98,P=0.867、0.158、0.053);组间比较差异均无统计学意义(F=3.34、1.26,P=0.040、0.288).雷珠单抗组术后6个月CME发生率(17.2％,5/29)与注药前(34.5％,10/29)比较差异均无统计学意义(x2=2.25,P=0.115),康柏西普组术后6个月CME发生率(10.0％,3/30)与注药前(36.7％,11/30)比较差异有统计学意义(x2=5.96,P=0.015),阿柏西普组术后6个月CME发生率(14.8％,4/27)与注药前(40.7％,11/27)比较差异有统计学意义(x2=4.52,P=0.033);注药前与PPV术后6个月3组间CME比率比较差异均无统计学意义(x2=0.24、0.67,P=0.887、0.739).结论 PPV术前应用雷珠单抗、康柏西普和阿柏西普玻璃体内注射治疗PDR均安全有效,而康柏西普及阿柏西普降低术后CME发生率更为有效.

Abstract

Objective To evaluate the clinical efficacy of different types of intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs before pars plana vitrectomy(PPV)for the treatment of proliferative diabetic retinopathy(PDR).Methods This was a prospective randomized controlled study.Ninty eyes of 90 PDR patients in Tianjin Medical University General Hospital from Jul.2019 to Dec.2022 were selected as the study subjects.The patients were divided into three groups by a random number table method:a ranibizumab group(30 cases,30 eyes),a conbercept group(30 cases,30 eyes),and an aflibercept group(30 cases,30 eyes).All patients initially received intravitreal injections of the corresponding drugs,followed by PPV within 3-4 days.Best corrected visual acuity(BCVA,logMAR),central macular thickness(CMT),and the rate of cystoid macular edema(CME)were compared among the three groups before and at 6 months after PPV.Results Twenty-nine cases(96.7％)in the ranibizumab group,30 cases(100.0％)in the conbercept group,and 27 cases(90.0％)in the aflibercept group completed the follow-up finally.BCVA in the ranibizumab group,the conbercept group,and the aflibercept group were 1.83±0.69,0.78±0.52;1.86±0.78,0.70±0.71;and 2.03±0.63,0.76±0.60 before intravitreal injection and at 6 months after PPV,with significant improvements postoperatively,and the difference was statistically significant(t=6.46,6.01,7.62;all P＜0.001).The difference was of no statistical significance among the three groups(F=0.76,0.24;P=0.470,0.787).CMT of the three groups was(306.32±124.04),(300.86±118.98);(304.86±76.35),(271.20±102.03);and(371.67±129.54),(308.63±13.03)μm before intravitreal injection and at 6 months after PPV,respectively.There were no significant differences in CMT of the three groups when compared with that before intravitreal injection(t=0.17,1.43,1.98;P=0.867,0.158,0.053),and the difference was not statistically significant among the three groups(F=3.34,1.26;P=0.040,0.288).The rate of CME in the ranibizumab group before intravitreal injection and at 6 months after PPV were 34.5％(10/29)and 17.2％(5/29).The difference was of no statistical significance(x2=2.25,P=0.115),while the rate of CME in the conbercept group before intravitreal injection and at 6 months after PPV was 36.7％(11/30)and 10.0％(3/30),and the difference was statistically significant(x2=5.96,P=0.015).The rate of CME in the aflibercept group before intravitreal injection and at 6 months after PPV were 40.7％(11/27)and 14.8％(4/27),and the difference was statistically significant(x2=4.52,P=0.033).However,there was no significant difference in the rate of CME among the three groups(x2=0.24,0.67;P=0.887,0.739).Conclusion Intravitreal injection of ranibizumab,conbercept,and aflibercept before PPV have similar clinical efficacy and safety in the treatment of PDR.Conbercept and aflibercept are more effective than ranibizumab in reducing the occurrence of postoperative CME.

关键词

糖尿病视网膜病变/血管内皮生长因子类/玻璃体切除术/雷珠单抗/康柏西普/阿柏西普

Key words

Diabetic retinopathy/Vascular endothelial growth factors/Vitrectomy/Ranibizumab/Conbercept/Aflibercept

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出版年

2024
中华眼外伤职业眼病杂志
中华医学会

中华眼外伤职业眼病杂志

影响因子：0.622
ISSN：2095-1477
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