微创医学

目的探讨微创玻璃体切割治疗增殖性糖尿病视网膜病变(PDR)围术期中应用抗VEGF的价值。方法纳入PDR患者40例（40眼），随机分为A组（实验）20例：术前3 d玻璃体腔注射抗VEGF药物雷珠单抗0.5 mg；B组（空白对照）20例：术前不进行抗VEGF药物治疗。A组注药后3 d及B组均完成25G+玻璃体切割联合术中532激光全视网膜光凝。通过对手术时间、术中电凝次数、医源性裂孔率、视网膜前纤维增殖膜分级及术后6个月最佳矫正视力（BCVA）等观察指标进行分析，对两组的安全性和疗效进行评估。结果随访时间6～11（9.26±2.59）个月。A组手术时间、术中电凝次数明显少于B组，差异均具有统计学意义（P＜0.05）。术中纤维增殖膜分级比较，差异无统计学意义（P＞0.05）。术中发生医源性裂孔比较，A组发生2例（10%），B组8例（40%），A组较B组发生率明显减少，差异有统计学意义（P＜0.05）。A、B组术前BCVA平均字母数分别为（5.8±7.1）、（5.9±12.1），术后分别为（43.9±24.4）、（30.7±19.8），较各自术前均有明显提高，差异有统计学意义（P＜0.01）；术后A组BCVA平均字母数优于B组，差异无统计学意义（P＞0.05）。结论在微创玻璃体切割治疗糖尿病视网膜病变围手术期中应用抗VEGF，能缩短手术时间、减少手术中出血、减少医源性裂孔发生、有效改善患者视力。

ObjectiveTo explore the value of anti-VECF applied to perioperation of minimally invasive vitrectomy for proliferative diabetic retinopathy(PDR). MethodsForty patients(40 eyes) with PDR were enrolled and were randomly divided into group A(experimental group) and group B(blank control group), with 20 cases in each group. Intravitreal injection of anti-VECF agent (0.5mg of ranibizumad)was conducted in group A，and no injection of anti-VECF in group B. Then 25G+vitrectomy combined with intraoperative panretinal photocoagulation using 532 nm laser was conduced in group A after 3 days of administration and group B. The operative duration, frequency of intraoperative electric coagulation, incident rate of iatrogenic retinal holes, grade of preretinal fibrovascular proliferation and best corrected visual acuity (BCVA) after 6 months of operation were analyzed to evaluate the efficacy and safety of both groups. ResultsThe duration of follow-up was 6-11（9.26±2.59）months. The operative duration was shorter and the frequency of intraoperative electric coagulation was less in the group A compared to group B（all P＜0.05). There was no significant difference in the grade of preretinal fibrovascular proliferation between the two groups（P＞0.05）.Iatrogenic retinal holes occurred in 2 cases （10%）and 8 cases（40%）in group A and group B respectively, and the incident rate of group A was significantly lower than that of group B （all P＜0.05）.The result of BCVA test showed that the preoperative numbers of letters were（5.8±7.1）and（5.9±12.1）in group A and group B respectively, and the postoperative numbers were （43.9±24.4）and（30.7±19.8）in group A and group B respectively.The postoperative BCVA of both groups were improved（all P＜0.01）. The postoperative BCVA of group A was superior to that of group B, but no significant difference was found（P＞0.05）. ConclusionApplication of anti-VECF to perioperation of minimally invasive vitrectomy for diabetic retinopathy can shorten the operative duration, decrease the intraoperative blood loss, reduce the incidence of iatrogenic retinal holes and effectively improve the vision acuity of patients.