本文選題：光學(xué)相干斷層成像 + 糖尿病黃斑水腫�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:既往研究報(bào)道,行玻璃體切除手術(shù)后,未注入硅油的眼內(nèi)藥物分布及清除速率發(fā)生變化,目前關(guān)于玻璃體腔內(nèi)注射血管內(nèi)皮生長(zhǎng)因子(vascular endothelial growth factor,VEGF)抑制劑治療玻璃體切除術(shù)后糖尿病黃斑水腫(diabetic macular edema,DME)的研究較少。本次研究的主要目的是觀察并分析玻璃體腔注射雷珠單抗治療玻璃體切除術(shù)后DME的臨床療效。方法:選取既往接受玻璃體切除手術(shù),于2014年12月至2016年7月期間就診于大醫(yī)一院眼科確診為DME,并接受玻璃體腔注射雷珠單抗治療的患眼。記錄并整理入選患者的一般情況及�？魄闆r。其中一般情況,如性別、年齡、糖尿病(diabetes mellitus,DM)類型及病程、既往接受玻璃體切除手術(shù)的時(shí)間及病因、是否接受過(guò)白內(nèi)障手術(shù)治療、是否接受過(guò)眼內(nèi)激光治療以及激光治療的類型。�？魄闆r包括最佳矯正視力(best corrected visual acuity,BCVA)、裂隙燈眼前節(jié)檢查結(jié)果、眼底檢查結(jié)果、眼壓(intraocular pressure,IOP),以及應(yīng)用光學(xué)相干斷層成像(optical coherence tomography,OCT)測(cè)得的患者黃斑中心凹視網(wǎng)膜厚度(central macular thickness,CMT)。所有患者均給予玻璃體腔注射雷珠單抗0.5mg/0.05ml,每月1次,連續(xù)注射3次。測(cè)量并記錄患者術(shù)前及連續(xù)治療3個(gè)月后隨訪時(shí)的BCVA、CMT及IOP。應(yīng)用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,分析前BCVA換算成logMAR值,治療前及治療后BCVA、CMT和IOP的比較應(yīng)用配對(duì)樣本t檢驗(yàn),P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:本次研究共收集玻璃體切除術(shù)后DME患者28例(33眼),每月1次,連續(xù)注射3次。33眼治療前平均IOP為(17.45±2.77)mmHg,治療后平均IOP為(17.70±2.80)mmHg,治療前后差異無(wú)統(tǒng)計(jì)學(xué)意義(P = 0.45)。治療前BCVA(logMAR)為 0.22～1.30,平均為 0.58±0.27;治療后 BCVA 為 0.10～1.30,平均為0.55±0.28,較術(shù)前平均提高0.03(P = 0.52)。其中12只眼(36%)視力提高或降低0.1,視力較術(shù)前無(wú)明顯變化;9只眼(27%)視力降低≥0.1,其中3只眼(9%)視力降低≥0.3;12只眼(36%)視力提高≥0.1,其中3只眼(9%)的視力提高≥0.3。注藥前 CMT 為(290-450)um,平均為(371.39±76.58)um;治療后CMT為(234-410)um,平均為(320.09±77.34)um,CMT較術(shù)前平均下降14%(P = 0.01)。16只眼(48.5%)黃斑水腫吸收,OCT顯示視網(wǎng)膜內(nèi)和視網(wǎng)膜下無(wú)水腫增厚區(qū)。17只眼(51.5%)治療后OCT測(cè)量值表明仍存在黃斑水腫,其中6只眼(35%)有輕微的旁中心凹視網(wǎng)膜或視網(wǎng)膜前纖維增殖。在黃斑水腫吸收的16只眼中,僅2眼(13%)存在旁中心凹視網(wǎng)膜或視網(wǎng)膜前纖維增殖。部分患者盡管CMT較術(shù)前顯著降低,但視力無(wú)明顯改善。結(jié)論:玻璃體腔注射雷珠單抗能有效改善玻璃體切除術(shù)后的糖尿病黃斑水腫,降低黃斑中心凹視網(wǎng)膜厚度(CMT)。術(shù)后患者黃斑中心凹視網(wǎng)膜厚度(CMT)顯著下降,但最佳矯正視力(BCVA)較術(shù)前無(wú)明顯提高。
[Abstract]:Objective: Previous studies have reported changes in the distribution and clearance rate of intraocular drugs without silicone oil after vitrectomy. At present, the vascular endothelial growth factor (VEGF) inhibitor is currently used to treat diabetic macular edema after vitrectomy (diabetic macular edema, DM). The main purpose of this study was to observe and analyze the clinical effect of DME after vitrectomy in the treatment of vitrectomy by intravitreal injection of rezumumab. Methods: a previous vitrectomy was selected, and from December 2014 to July 2016, DME was diagnosed in the ophthalmology department of the great medical hospital, and the vitreous intravitre injection of ray beads was accepted. The general situation and special situation of the patients were recorded and collate. General conditions, such as sex, age, type and course of diabetes (diabetes mellitus, DM), the time and cause of previous vitrectomy, whether to receive cataract hand surgery, or not, have received intraocular laser treatment and laser treatment. The type of treatment included the best corrected visual acuity (best corrected visual acuity, BCVA), the results of the slit lamp anterior segment examination, the results of the fundus examination, the intraocular pressure (intraocular pressure, IOP), and the macular macular retinal thickness measured by the application of optical coherence tomography (optical coherence tomography, OCT). Thickness, CMT). All patients were given intravitreal injection of reelzumumab 0.5mg/0.05ml, 1 times a month, 3 consecutive injections. Measured and recorded the patients' BCVA, CMT and IOP. with SPSS17.0 software for 3 months before and after 3 months of continuous treatment. The former BCVA was converted into logMAR values, BCVA, CMT, and IOP. Compared with paired sample t test, P0.05 thought the difference was statistically significant. Results: 28 cases (33 eyes) of DME patients after vitrectomy were collected, 1 times a month, and the average IOP was (17.45 + 2.77) mmHg before continuous injection of 3.33 eyes, and the average IOP after treatment was (17.70 + 2.80) mmHg, and there was no statistical difference before and after treatment (P = 0.45). Before treatment, BCVA (logMAR) was 0.22 ~ 1.30, the average was 0.58 + 0.27, and BCVA was 0.10 ~ 1.30 after treatment, the average was 0.55 + 0.28, compared with the preoperative average of 0.03 (P = 0.52). Among them, the visual acuity of 12 eyes (36%) was improved or reduced, and the visual acuity decreased more than before the operation. ) improvement of visual acuity was more than 0.1, of which 3 eyes (9%) had improved visual acuity (290-450) um before 0.3. injection (290-450) um, average (371.39 + 76.58) um, CMT was (234-410) um, average (320.09 + 77.34) um, CMT compared with 14% (P = 0.01).16 (P = 0.01).16 only (48.5%) macular edema absorption, OCT display of retinal and subretinal edema thickening region.17. OCT measurements showed that there was still macular edema after treatment (51.5%), of which 6 eyes (35%) had a slight paracert retina or retinal preretinal fiber proliferation. In 16 eyes of macular edema, only 2 eyes (13%) had paracerpic retina or retinal preretinal fibers. Although CMT was significantly lower than before, no visual acuity was found in some patients. Conclusion: the intravitreal injection of amozumab can effectively improve diabetic macular edema after vitrectomy and decrease the retinal thickness of the macular fovea (CMT). The retinal thickness of the macular fovea (CMT) in the patients after surgery is significantly decreased, but the best corrected visual acuity (BCVA) is not significantly higher than that before operation.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R779.6
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本文編號(hào)：1774676