本文選題：全視網(wǎng)膜光凝術(shù) + 血管內(nèi)皮生長因子抑制劑　； 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：目的選取糖尿病性視網(wǎng)膜病變伴黃斑水腫的病人,分組治療,觀察單純?nèi)暰W(wǎng)膜光凝術(shù)和全視網(wǎng)膜光凝聯(lián)合玻璃體腔內(nèi)注射血管內(nèi)皮生長因子抑制劑的臨床療效及安全性。方法選擇自2015年9月至2016年7月就診于我院眼科的非增殖性糖尿病視網(wǎng)膜病變(III期)或增殖性糖尿病視網(wǎng)膜病變(IV期)且合并局灶性或彌漫性黃斑水腫的患者,共41例61只眼,其中男性患者14例,女性患者27例,平均年齡54.21±9.61歲。激光組24人38只眼,男10例,女14例,平均年齡53.00±8.75歲,每周1次在門診行視網(wǎng)膜光凝術(shù),共3-4次,方可完成全視網(wǎng)膜光凝。聯(lián)合組17人23只眼,男4例,女13例,平均年齡56.13±10.88歲,每月1次共2次在手術(shù)室內(nèi)進行玻璃體腔注射抗VEGF藥物(21只眼注射康柏西普,2只眼注射雷珠單抗)。首次注藥后1周,開始門診分期完成PRP,方法同激光組。利用標準對數(shù)視力表隨訪治療前、治療后第1周、第1個月,第3個月時最佳矯正視力,利用光學相干斷層掃描儀隨訪兩組患者治療前、治療后第1周、第1個月,第3個月時的黃斑區(qū)體積和黃斑區(qū)視網(wǎng)膜厚度的改變。將這些數(shù)據(jù)輸入統(tǒng)計軟件SPSS17.0進行分析,觀察兩組數(shù)據(jù)的統(tǒng)計學結(jié)果,評估兩者的臨床療效。結(jié)果激光組患者在完成全視網(wǎng)膜光凝術(shù)后,視力相對穩(wěn)定,無明顯提高或下降(P0.05),黃斑區(qū)平均視網(wǎng)膜厚度和黃斑區(qū)總體積在術(shù)后1周、術(shù)后1個月、術(shù)后3個月較術(shù)前均有不同程度增加(P0.05),且術(shù)后1個月時最顯著。術(shù)后3個月時數(shù)據(jù)又有所回落,但仍稍高于術(shù)前。黃斑區(qū)中心視網(wǎng)膜厚度在術(shù)后1周、1月較術(shù)前有所增加,差異具有統(tǒng)計學意義(P0.05),術(shù)后3個月時基本恢復到術(shù)前水平(P0.05)。聯(lián)合組患者視力較術(shù)前有相應提高,黃斑區(qū)視網(wǎng)膜平均厚度、中心厚度和總體積在術(shù)后各時間段較術(shù)前有不同程度下降,差異均有統(tǒng)計學意義(P0.05)。結(jié)論(1)全視網(wǎng)膜光凝術(shù)可以防止患眼病情惡化,視力下降,是治療糖尿病性視網(wǎng)膜病變經(jīng)典而有效的方式。短期內(nèi)可能會加重黃斑水腫,但隨時間推移會有所改善,可恢復至術(shù)前水平。(2)玻璃體腔注射血管內(nèi)皮生長因子抑制劑聯(lián)合全視網(wǎng)膜激光光凝治療糖尿病性視網(wǎng)膜病變療效顯著,可改善黃斑水腫,提高患者視力,且較為安全。(3)光學相干斷層掃描儀具有非接觸、非侵入性,高分辨率及定量分析等優(yōu)點,可以客觀顯示眼底黃斑區(qū)視網(wǎng)膜厚度與體積的變化,適用于糖尿病視網(wǎng)膜病變患者的病情隨訪。
[Abstract]:Objective to observe the clinical efficacy and safety of total retinal photocoagulation and intravitreal injection of vascular endothelial growth factor inhibitor in patients with diabetic retinopathy with macular edema. Methods from September 2015 to July 2016, 41 cases (61 eyes) of non-proliferative diabetic retinopathy (stage III) or proliferative diabetic retinopathy (stage IV) with focal or diffuse macular edema were selected. There were 14 males and 27 females with an average age of 54.21 鹵9.61 years. In the laser group, 38 eyes (10 males and 14 females) with an average age of 53.00 鹵8.75 years, underwent retinal photocoagulation once a week, 3 to 4 times a week, in order to complete the whole retinal photocoagulation. In the combined group, 23 eyes (male 4, female 13, mean age 56.13 鹵10.88) were treated with intravitreal intravitreous injection of anti-VEGF drugs (21 eyes were injected with Compactopril 2 eyes). One week after the first injection, the PRP was completed by stages in the outpatient clinic, and the same method was used in the laser group. Standard logarithmic visual acuity chart was used to follow up before treatment, 1 week, 1 month and 3 months after treatment. Optical coherence tomography was used to follow up the two groups before treatment, 1 week after treatment, 1 month after treatment. Changes of macular area volume and macular retinal thickness at 3 months. These data were input into the statistical software SPSS 17.0 to analyze and observe the statistical results of the two groups of data and evaluate the clinical efficacy of the two groups. Results in the laser group, the visual acuity was relatively stable, without significant improvement or decrease (P0.05). The mean retinal thickness and the total volume of macular area in the laser group were 1 week after operation and 1 month after operation. Three months after operation were increased in varying degrees compared with those before operation (P0.05), and the most significant at 1 month after operation. After 3 months, the data decreased, but still slightly higher than before. The central retinal thickness of macular area increased in 1 week and 1 month after operation (P0.05), and recovered to the preoperative level 3 months after operation (P0.05). The mean retinal thickness, central thickness and total volume of macular area in the combined group were significantly lower than those before the operation (P0.05). Conclusion (1) Total retinal photocoagulation is a classic and effective method for the treatment of diabetic retinopathy. Macular edema may be aggravated in the short term, but it will be improved over time and can recover to the preoperative level. (2) the effect of intravitreal injection of vascular endothelial growth factor inhibitor combined with whole retinal laser photocoagulation on diabetic retinopathy is remarkable. It can improve macular edema and improve the visual acuity of the patients. (3) Optical coherence tomography has the advantages of non-contact, non-invasive, high resolution and quantitative analysis, and can objectively display the changes of retinal thickness and volume in the macular area. It is suitable for the follow-up of diabetic retinopathy.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.2;R779.63

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