Evaluation of Intravitreal Ranibizumab on the Surgical Outcome for Diabetic Retinopathy With Tractional Retinal Detachment.
Evaluation of Intravitreal Ranibizumab on the Surgical Outcome for Diabetic Retinopathy With Tractional Retinal Detachment.
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DOI：
10.1097/md.0000000000002731
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发表时间：
2016-02
期刊：
影响因子：
1.6
通讯作者：
Lou D
中科院分区：
文献类型：
--
作者：
Dong F;Yu C;Ding H;Shen L;Lou D
本研究旨在探讨玻璃体内注射雷尼比珠单抗对合并牵拉性视网膜脱离但术前未接受任何视网膜光凝的糖尿病患者手术效果的影响。对97例(97只眼)合并牵拉性视网膜脱离的糖尿病视网膜病变患者行23-G平坦部玻璃体切割术。随机分为实验I组(n = 47眼)和对照组(n = 50眼)。I组在手术前1周玻璃体腔内注射雷尼比珠单抗(Lucentis 0.5 mg/0.05 mL)，II组直接手术。术后随访6个月~3年(16 ± 6个月)，观察最佳矫正视力、并发症及光学相干断层扫描测量黄斑视网膜厚度等指标。I组术后视力由对数MAR1.92 ± 0.49提高至对数MAR0.81 ± 0.39，而II组由对数MAR1.91 ± 0.49改善至对数MAR0.85 ± 0.41。术后视力有明显提高，但术后随访时两组间差异无统计学意义。玻璃体切割手术时间，I组为(40 ± 7) 分钟，II组为(53 ± 9) 分钟，差异有统计学意义(P<0.05)。医源性破裂，实验组5只眼(11%)，对照组17只眼(34%)，差异有统计学意义。OCT测量黄斑视网膜厚度，I组为(2 5 6 ± 44)μm，II组为(2 99 ± 84)μm，差异有统计学意义。此外，组II中需要硅油填塞和术后视网膜光凝的眼明显增多。23-GPPV联合玻璃体内填塞和全视网膜光凝仍是治疗糖尿病视网膜病变合并牵引性视网膜脱离的有效方法。术前玻璃体内注射雷尼比单抗可缩短手术时间，减少术中并发症，有时还可省去硅油填塞和术后视网膜光凝，减轻患者的手术痛苦。
This study aims to investigate intravitreal injection of Ranibizumab on the surgical outcome for diabetic patients who had tractional retinal detachment but did not receive any preoperative retinal photocoagulation. Ninety-seven patients (97 eyes) who had diabetic retinopathy with tractional retinal detachment were enrolled to receive 23-G pars plana vitrectomy (PPV). They were assigned to an experimental group (Group I, n = 47 eyes) and a control group (Group II, n = 50 eyes). The patients in Group I were given 1 injection of intravitreal Ranibizumab (Lucentis 0.5 mg/0.05 mL) 1 week before surgery, whereas those in Group II went down to surgery directly. Follow-ups were performed for 6 months to 3 years (16 ± 6 months), and indicators observed included postoperative best-corrected visual acuity, complications, and retinal thickness in the macula measured by optical coherence tomography. In Group I, BCVA improved from logMAR 1.92 ± 0.49 to logMAR 0.81 ± 0.39 following surgery, whereas in Group II, BCVA improved from logMAR 1.91 ± 0.49 to logMAR 0.85 ± 0.41. There was significant postoperative gain in vision, but there was no significant difference between the 2 groups at postoperative follow-up visits. The mean duration of vitrectomy in Group I and Group II was (40 ± 7) minutes and (53 ± 9) minutes, respectively, with significant difference. Iatrogenic breaks were noted in 5 eyes (11%) in the experimental group and 17 eyes (34%) in the control group; the difference was significant. The retinal thickness in the macula measured by OCT was (256 ± 44) μm and (299 ± 84) μm in Group I and Group II respectively with significant difference. Besides, there were significantly more eyes in Group II that required silicone oil tamponade and postoperative retinal photocoagulation. 23-G PPV combined with intravitreal tamponade and panretinal photocoagulation still remains an effective regimen for the treatment of diabetic retinopathy complicated with tractional retinal detachment. Preoperative intravitreal injection of Ranibizumab could shorten surgical duration, reduce intraoperative complications, and sometimes spare the need for silicone oil tamponade and postoperative retinal photocoagulation, alleviating patients’ suffering from surgery.