[1]梁泽玉,陈松,何广辉,等.术前及术中2次应用康柏西普辅助玻璃体切割术治疗增生型糖尿病视网膜病变的临床研究[J].眼科新进展,2019,39(2):162-167.[doi:10.13389/j.cnki.rao.2019.0037]
　LIANG Ze-Yu,CHEN Song,HE Guang-Hui,et al.Clinical observation of the application of conbercept preoperatively and intraoperatively assisted to the vitrectomy in the treatment of proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2019,39(2):162-167.[doi:10.13389/j.cnki.rao.2019.0037]
点击复制

术前及术中2次应用康柏西普辅助玻璃体切割术治疗增生型糖尿病视网膜病变的临床研究/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
39卷
期数:
2019年2期
页码:
162-167
栏目:
应用研究
出版日期:
2019-02-05

文章信息/Info

Title:
Clinical observation of the application of conbercept preoperatively and intraoperatively assisted to the vitrectomy in the treatment of proliferative diabetic retinopathy
作者:
梁泽玉; 陈松; 何广辉; 王俊华; 高翔; 武斌
300020　天津市，天津医科大学眼科临床学院，天津市眼科医院，天津市眼科学与视觉科学重点实验室，天津市眼科研究所
Author(s):
LIANG Ze-Yu; CHEN Song; HE Guang-Hui; WANG Jun-Hua; GAO Xiang; WU Bin
Clinical College of Ophthalmology of Tianjin Medical University，Tianjin Eye Hospital，Tianjin Key Lab of Ophthalmology and Visual Science，Tianjin Eye Institute，Tianjin 300020，China
关键词:
增生型糖尿病视网膜病变; 康柏西普; 玻璃体切割术; 玻璃体内积血
Keywords:
proliferative diabetic retinopathy; Conbercept; pars plana vitrectomy; postoperative vitreous haemorrhage
分类号:
R774.1
DOI:
10.13389/j.cnki.rao.2019.0037
文献标志码:
A
摘要:
目的　对比并分析术前1次、术前及术中2次玻璃体内注射康柏西普（intravitreal injection conbercept，IVC）辅助玻璃体切割术（pars plana vitrectomy，PPV）治疗增生型糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）患者术中及术后临床指标的不同。方法　回顾性随机病例对照研究，依据纳入及排除标准将确定为严重PDR患者并需行PPV治疗的158例162眼纳入研究。依据IVC次数分为3组：A组为单纯PPV组48例50眼，B组为术前1次IVC组61例63眼，C组为术前及术中2次IVC组49例49眼。3组患眼临床基线资料差异均无统计学意义（均为P>0.05）。所有患眼手术操作均由同一名术者完成，统计并分析3组患眼的PPV手术时间、术中严重出血率、术后玻璃体内积血（postoperative vitreous cavity haemorrhage，POVCH）发生率、术后不同时间POVCH发生率、术后不同程度POVCH发生率、术后1个月与3个月最佳矫正视力（best corrected visual acuity，BCVA）、术后1个月与3个月BCVA提高率。结果　B组、C组的PPV手术时间［（87.85±12.37）min、(88.45±13.66)min］及术中严重出血发生率(12.70%、12.24%)均低于A组［(91.02±17.90)min、34.00%］（F=24.709，P<0.05；χ2=11.330，P<0.05）；C组术后3个月内POVCH发生率及严重出血程度均低于A组、B组(均为P<0.05)；C 组术后POVCH出血程度均轻于A组、B组，C组术后1个月BCVA均高于A组、B组，C组术后1个月及术后3个月BCVA提高率分别高于A组及B组（χ2=14.038，P<0.05；χ2=11.076，P<0.05）。结论　PPV术前及术中2次IVC可有效降低PDR患者术后短期（1个月）内POVCH的发生率，减轻POVCH出血程度，改善PDR患者术后视力。
Abstract:
Objective　To compare the differences in the clinical parameters of proliferative diabetic retinopathy（PDR）patients underwent pars plana vitrectomy (PPV) received the treatment of the intravitreous injection of conbercept (IVC) single time preoperatively or two times preoperatively and intraoperatively.Methods　A retrospective randomized case-control study was conducted.There were 162 eyes of 158 patients with PDR underwent PPV included into the study according to inclusion and exclusion criteria.The patients were divided into 3 groups according to the frequency of IVC:50 eyes of 48 patients as group A received no IVC,63 eyes of 61 patients as group B who received single IVC preoperatively and 49 eyes of 49 patients as group C received twice IVC preoperatively and intraoperatively.There were no statistically significant differences in the clinical subjective baseline of three groups (all P>0.05).All the patients underwent the operations by the same operator.The analysis included the mean operative time of PPV,the rate of intraoperative hemorrhage,the rate of postoperative vitreous cavity hemorrhage (POVCH) at 1 month and 3 months during the follow-up,the degree of the POVCH and the visual acuity distribution at 1 month and 3 months postoperatively,the rate of visual acuity improvement at 1 month and 3 months postoperatively.Results　The mean operative time［(87.85±12.37)min,(88.45±13.66)min］and the rate of severe intraoperative hemorrhage (12.70%,12.24%) of group B and C were lower than those of group A［(91.02±17.90)min,34.00%］ (F=24.709,P<0.05;χ2=11.330,P<0.05).The rate and the degree of POVCH of group C were lower than those of group A and group B during the follow-up (both P<0.05);the degree of POVCH of group C was lower than that of the other groups during follow-up.The improvement of best corrected visual acuity (BCVA) of group C was better than that of the other groups at 1-month postoperatively.The rate of BCVA improvement of the group C at the 1-month and 3-month were significantly higher than that of the other groups (χ2=14.038,P<0.05;χ2=11.076,P<0.05).Conclusion　The treatment of 2 times of IVC preoperatively and intraoperatively assisted to PPV is safe for severe PDR patients,which can statistically reduce the operative time,decrease the rates of intraoperative hemorrhage and POVCH,alleviate degree of POVCH especially at the early stage(one month postoperative) and improve the outcomes of postoperative visual acuity of PDR patients.

参考文献/References:

［1］　MILLER J W，ADAMIS A P，AIELLO L P.Vascular endothelial growth factor in ocular neovascularization and proliferative diabetic retinopathy［J］.Diabetes Metab Rev，1997，139(1)：37-50.
［2］　YU Y，ZHANG J，ZHU R，ZHAO R，CHEN J，JIN J，et al.The profile of angiogenic factors in vitreous humor of the patients with proliferative diabetic retinopathy［J］.Curr Mol Med，2017，17(4)：280-286.
［3］　MODARRES M，NAZARI H，FALAVARJANI K G，NASERIPOUR M，HASHEMI M，PARVARESH M M.Intravitreal injection of bevacizumab before vitrectomy for proliferative diabetic retinopathy［J］.Eur J Ophthalmol，2009，19(5)：848-852.
［4］　El-BATARNY A M.Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy［J］.Clin Ophthalmol，2008，2(4)：709-716.
［5］　DA RLUCENA D，RIBEIRO J A，COSTA R A，BARBOSA J C，SCOTT I U，DE FIGUEIREDO-PONTES L L，et al.Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study)［J］.Br J Ophthalmol，2009，93(5)：688-691
［6］　ROMANO M R，GIBRAN S K，MARTICORNEA J，WONG D，HEIMANN H.Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous haemorrhage［J］?Eye (Lond)，2009，23(8)：1698-701.
［7］　LO W R，KIM S J，AABERG T M，BERGSTROM C，SRIVASTAVA S K，YAN J，et al.Visual outcomes and incidence of recurrent vitreous hemorrhage after vitrectomy in diabetic eyes pretreated with bevacizumab (avastin)［J］.Retina，2009，29(7)：926-931.
［8］　ZHANG M，ZHANG J，YAN M，LUO D，ZHU W，KAISER P K，et al.A phase 1 study of KH902，a vascular endothelial growth factor receptor decoy，for exudative age-related macular degeneration［J］.Ophthalmology，2011，118(4)：672-678.
［9］　HOLLADAY J T.Proper method for calculating average visual acuity［J］.J Refract Surg，1997，13(4)：388-391.
［10］　The Ocular Fundus Disease Group of the Department of Ophthalmology of Chinese Academy of Medical Science.The criterion of grading diabetic retinopathy［J］.Ocul Fund Dis，1985，1(1)：42.
中华医学会眼科学分会眼底病学组.糖尿病视网膜病变分期标准［J］.眼底病，1985，1(1)：42．
［11］　YEH P T，YANG C M，YANG C H，HUANG J S.Cryotherapy of the anterior retina and sclerotomy sites in diabetic vitrectomy to prevent recurrent vitreous hemorrhage：an ultrasound biomicroscopy study［J］.Ophthalmology，2005，112(12)：2095-2102.
［12］　SHI L，HUANG Y F.Postvitrectomy diabetic vitreous hemorrhage in proliferative diabetic retinopathy［J］.J Res Med Sci，2012，17(9)：865-871.
［13］　SMITH J M，STEEL D H.Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy［J］.Cochrane Database Syst Rev，2015，7(8)：CD008214.
［14］　ABDALLAH W，FAWZI A A.Anti-VEGF therapy in proliferative diabetic retinopathy［J］.Int Ophthalmol Clin，2009，49(2)：95-107.
［15］　HUSSAIN N，GHANEKAR Y，KAUR I.The future implications and indications of anti-vascular endothelial growth factor therapy in ophthalmic practice［J］.Indian J Ophthalmol，2007，55(6)：445-450.
［16］　GRAGOUDAS E S，ADAMIS A P，CUNNINGHAM E T Jr，FEINSOD M，GUYER D R.Pegaptanib for neovascular age-related macular degeneration［J］.N Engl J Med，2004，351(27)：2805-2816.
［17］　STEWART M W.Aflibercept (VEGF Trap-Eye) for the treatment of exudative age-related macular degeneration［J］.Expert Rev Clin Pharmacol，2013，6(2)：103-113.
［18］　LI H，LEI N，ZHANG M，LI Y，XIAO H，Hao X.Pharmacokinetics of a long-lasting anti-VEGF fusion protein in rabbit［J］.Exp Eye Res，2012，97(1)：154-159.
［19］　LI F，ZHANG L，WANG Y，LI Y，XIAO H，MA A，et al.One-year outcome of conbercept therapy for diabetic macular edema［J］.Curr Eye Res，2018，43(2)：218-223.
［20］　YANG W，TAN Y，LI C，LIU Y，LU G.Observation of curative effect of intravitreal injection of conbercept in wet age-related macular degeneration：Optical coherence tomography analysis after injection［J］.Microsc Res Tech，2018，81(4)：384-388.
［21］　HUANG Z，DING Q，YAN M，LIAN H，CHEN Z，CHEN X，et al.Short-term efficacy of Conbercept and Ranibizumab for polypoidal choroidal vasculopathy［J］.Retina，2018，Epub ahead of print.
［22］　JIN E，YIN H，LIX，ZHAO M.Short-term outcomes after intravitreal injections of Conbercept versus Ranibizumab for the treatment of retinopathy of prematurity［J］.Retina，2018，38(8)：1595-1604.
［23］　SU L，REN X，WEI H，ZHAO L，ZHANG X，LIU J，et al.Intravitreal conbercept (KH902) for surgical treatment of severe proliferative diabetic retinopathy［J］.Retina，2016，36(5)：938-943.
［24］　DONG F，YU C，DING H，SHEN L，LOU D.Evaluation of intravitreal Ranibizumab on the surgical outcome for diabetic retinopathy with tractional retinal detachment［J］.Medicine (Baltimore)，2016，95(8)：e2731.
［25］　YORSTON D，WICKHAM L，BENSON S，BUNCE C，SHEARD R，CHARTERIS D.Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy［J］.Br J Ophthalmol，2008，92(3)：365-368.
［26］　VITATA S R，KYLSTRA J A.Postoperative complications following vitrectomy for proliferative diabetic retinopathy with sewon and noncontact wide-angle viewing lenses［J］.Ophthalmic Surg Lasers，2001，32(3)：193-197.
［27］　YANG C M，YEH P T，YANG C H.Intravitreal long-acting gas in the prevention of early postoperative vitreous hemorrhage in diabetic vitrectomy［J］.Ophthalmology，2007，114 (4)：710-715.
［28］　GUO J，CHEN S，WANG Y，LIANG X.Clinical effect of vitreoretinal surgery combined with intravitreal injection of conbercept or ranibizumab on severe proliferative diabetic retinopathy［J］.Chin J Exp Ophthalmol，2017，35(10)：914-919.
郭婧，陈松，王昀，梁旭.玻璃体视网膜手术联合玻璃体腔注射康柏西普或雷珠单抗治疗严重PDR的临床观察［J］.中华实验眼科杂志，2017，35(10)：914-919.
［29］　YOSHIDA S，KOBAYASHI Y，NAKAO S，SASSA Y，HISATOMI T，IKEDA Y，et al.Differential association of elevated inflammatory cytokines with postoperative fibrous proliferation and neovascularization after unsuccessful vitrectomy in eyes with proliferative diabetic retinopathy［J］.Clin Ophthalmol，2017，11：1697-1705.
［30］　SUZUKI Y，SUZUKI K，KUDO T，METOKI T，NAKAZAWA M.Level of vascular endothelial growth factor in the vitreous fluid of proliferative diabetic retinopathy patients and prognosis after vitrectomy［J］.Ophthalmologica，2016，236(3)：133-138.
［31］　FUNATSU H，YAMASHITA H，IKEDA T，MIMURA T，EGUCHI S，HORI S.et al.Vitreous levels of interleukin-6 and vascular endothelial growth factor are related to diabetic macular edema［J］.Ophthalmology，2003，110(9)：1690-1696.
［32］　CHEEMA R A，MUSHTAQ J，AL-KHARS W，AL-ASKAR E，CHEEMAMA.Role of intravitreal bevacizumab (Avastin) injected at the end of diabetic vitrectomy in preventing postoperative recurrent vitreous hemorrhage［J］.Retina，2010，30(10)：1646-1650.
［33］　AHN J，WOO S J，CHING H，PARK K H.The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy［J］.Ophthalmology，2011，118：2218-2226.
［34］　STEFNSSON.Physiology of vitreous surgery［J］.Graefes Arch Clin Exp Ophthalmol，2009，247(2)：147-163.
［35］　SATO T，TSUBOI K，NAKASHIMA H，EMI K.Characteristics of cases with postoperative vitreous hemorrhage after 25-gauge vitrectomy for repair of proliferative diabetic retinopathy［J］.Graefes Arch Clin Exp Ophthalmol，2017，255(4)：665-671.
［36］　YANG X，XU J，WANG R，MEI Y，LEI H，LIU J，et al.A randomized controlled trial of conbercept pretreatment before vitrectomy in proliferative diabetic retinopathy［J］.J Ophthalmol，2016,2016：2473234.

相似文献/References:

[1]衡欣 陈悦.增生型糖尿病视网膜病变患者血清中转化生长因子-β1和结缔组织生长因子水平的变化及意义[J].眼科新进展,2013,33(4):000.
[2]赵新荣,杨炜,邱明磊,等.玻璃体内注射雷珠单抗联合玻璃体切割术治疗严重增生型糖尿病视网膜病变[J].眼科新进展,2015,35(11):1064.[doi:10.13389/j.cnki.rao.2015.0291]
　ZHAO Xin-Rong,YANG Wei,QIU Ming-Lei,et al.Ranibizumab injection and vitrectomy for severe proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2015,35(2):1064.[doi:10.13389/j.cnki.rao.2015.0291]
[3]张娣,张玲,杨静,等.玻璃体内注射康柏西普联合手术及全视网膜光凝治疗新生血管性青光眼[J].眼科新进展,2015,35(12):1170.[doi:10.13389/j.cnki.rao.2015.0320]
　ZHANG Di,ZHANG Ling,YANG Jing,et al.Intravitreal injection of conbercept combined with operation and panretinal photocoagulation for neovascular glaucoma[J].Recent Advances in Ophthalmology,2015,35(2):1170.[doi:10.13389/j.cnki.rao.2015.0320]
[4]李娜,张杰,高荣玉,等.单次注射康柏西普治疗渗出型AMD患者RPE隆起面积与容积变化[J].眼科新进展,2016,36(2):172.[doi:10.13389/j.cnki.rao.2016.0047]
　LI Na,ZHANG Jie,GAO Rong-Yu,et al.Changes of retinal pigment epithelium uplift area and volume in exudative age-related macular degeneration after once injection of conbercept[J].Recent Advances in Ophthalmology,2016,36(2):172.[doi:10.13389/j.cnki.rao.2016.0047]
[5]刘建伟,李聪伶,于海群.雷珠单抗玻璃体内注射对增生型糖尿病视网膜病变玻璃体切割术效果的影响[J].眼科新进展,2016,36(3):265.[doi:10.13389/j.cnki.rao.2016.0071]
　LIU Jian-Wei,LI Cong-Ling,YU Hai-Qun.Effects of intravitreal injection of ranibizumab on vitrectomy for proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2016,36(2):265.[doi:10.13389/j.cnki.rao.2016.0071]
[6]饶玉萍,徐玲娟,肖紫云,等.增生型糖尿病视网膜病变患者血浆和玻璃体中VEGF和低密度脂蛋白受体相关蛋白6的表达及其相关性[J].眼科新进展,2016,36(3):278.[doi:10.13389/j.cnki.rao.2016.0075]
　RAO Yu-Ping,XU Ling-Juan,XIAO Zi-Yun,et al.Expression and correlation of LRP6 and VEGF in plasma and vitreous of PDR patients[J].Recent Advances in Ophthalmology,2016,36(2):278.[doi:10.13389/j.cnki.rao.2016.0075]
[7]王琛,李东豪,闻毅颐.玻璃体内注射康柏西普联合周边视网膜选择性光凝治疗视网膜静脉阻塞继发黄斑水肿的疗效及安全性[J].眼科新进展,2016,36(5):471.[doi:10.13389/j.cnki.rao.2016.0126]
　WANG Chen,LI Dong-Hao,WEN Yi-Yi.Intravitreal injection of conbercept combined with selective peripheral retinal photocoagulation for macular edema secondary to retinal vein occlusion[J].Recent Advances in Ophthalmology,2016,36(2):471.[doi:10.13389/j.cnki.rao.2016.0126]
[8]王玮,徐玲娟,蔡苏博,等.角膜基质及结膜下单次注射康柏西普治疗角膜新生血管的疗效及安全性[J].眼科新进展,2016,36(8):725.[doi:10.13389/j.cnki.rao.2016.0192]
　WANG Wei,XU Lin-Juan,CAI Su-Bo,et al.Efficacy and safety of one dose intrastromal and subconjunctival conbercept injection for corneal neovascularization[J].Recent Advances in Ophthalmology,2016,36(2):725.[doi:10.13389/j.cnki.rao.2016.0192]
[9]史志洁,张金嵩,吕晓贝.玻璃体内注射康柏西普联合手术治疗伴玻璃体积血的新生血管性青光眼[J].眼科新进展,2016,36(8):751.[doi:10.13389/j.cnki.rao.2016.0200]
　SHI Zhi-Jie,ZHANG Jin-Song,LV Xiao-Bei.Intravitreal injection of conbercept and surgical treatment for neovascular glaucoma combined with vitreous hemorrhage[J].Recent Advances in Ophthalmology,2016,36(2):751.[doi:10.13389/j.cnki.rao.2016.0200]
[10]孙丽丽,季拓.贝伐单抗联合全视网膜光凝治疗增生型糖尿病视网膜病变的疗效观察[J].眼科新进展,2016,36(10):949.[doi:10.13389/j.cnki.rao.2016.0254]
　SUN Li-Li,JI Tuo.Effects of bevacizumab combined with panretinal photocoagulation on proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2016,36(2):949.[doi:10.13389/j.cnki.rao.2016.0254]
[11]薛鹏程,游志鹏,付书华,等.23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普治疗增生型糖尿病视网膜病变（PDR）的疗效分析[J].眼科新进展,2017,37(5):458.[doi:10.13389/j.cnki.rao.2017.0116]
　XUE Peng-Cheng,YOU Zhi-Peng,FU Shu-Hua,et al.Preoperative and intraoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy[J].Recent Advances in Ophthalmology,2017,37(2):458.[doi:10.13389/j.cnki.rao.2017.0116]

更新日期/Last Update: 2019-02-18