目的 观察并分析微创玻璃体视网膜手术(VRS)术中注射康柏西普对严重增生性糖尿病视网膜病变(PDR)的临床疗效.方法 采用前瞻性非随机临床对照试验.纳入2015年6月至2016年3月于天津市眼科医院收治的严重PDR患者57例60眼,按照VRS术中是否注射康柏西普分为康柏西普注射组和对照组.康柏西普注射组患者VRS术毕玻璃体腔注射康柏西普0.05 ml,对照组仅行VRS.2个组手术操作均由同一医生完成,术后随访6～10个月.对比分析2个组术后一过性高眼压、早期和晚期玻璃体积血(VH)复发率、视网膜前增生膜及牵拉性视网膜脱离(TRD)和新生血管性青光眼(NVG)等并发症,术后黄斑中心凹视网膜厚度(CRT)、最小分辨角对数(LogMAR)最佳矫正视力(BCVA)情况.结果 康柏西普注射组早期VH发生率为6.7％(2/30),明显低于对照组的26.7％(8/30),差异有统计学意义(χ2=4.32,P=0.04);2个组发生晚期VH者分别有1眼和3眼,发生率分别为3.3％和10.0％,差异无统计学意义(χ2=1.07,P>0.05).2个组术后一过性高眼压、视网膜前增生膜和NVG等并发症情况比较,差异均无统计学意义(χ2=0.69、0.22、2.07,均P>0.05).康柏西普注射组CRT变化值较对照组大,差异有统计学意义(t=-3.23,P<0.05).2个组术后1个月、6个月平均LogMAR BCVA均较术前有不同程度提高,术后6个月2个组平均LogMAR BCVA比较,差异均有统计学意义(均P<0.05).结论 严重PDR患者VRS术中注射康柏西普可使术后早期VH发生率降低,CRT变薄,患者术后视力提高.%Objective To observe and analysis the clinical effects and postoperative complications of intravitreal injection of conbercept during vitrectomy surgery ( VRS ) in severe proliferative diabetic retinopathy ( PDR) treatment. Methods This is a prospective non.randomized controlled clinical study. A total of fifty.seven patients (sixty eyes) with severe PDR were enrolled in Tianjin Eye Hospital from June 2015 to March 2016,and the patients were divided into conbercept injection group and control group according to the patients ' surgical method intention selection. The patients in conbercept injection group received an intravitreal injection of 0. 05 ml conbercept solution during the surgery. The patients in control group only received VRS. The operations of the two groups were completed by the same doctor, and the follow.up time was 6 to 10 months after the surgery. The incidence of postoperative complications including a transient high intraocular pressure, early and late incidence of vitreous hemorrhage(VH),epiretinal membrane and traction retinal detachment(TRD),neovascular glaucoma(NVG),the central retinal thickness ( CRT ) and the best corrected visual acuity ( BCVA ) ( LogMAR visual acuity ) were comparatively analyzed. Results The incidence of early VH was 6. 7％( 2/30 ) in conbercept injection group, which was significantly lower than 26. 7％(8/30) in control group (χ2=4. 32,P=0. 04). The incidences of late VH were 3. 3％(1/30) and 10. 0％(3/30) in conbercept injection group and control group,and the differences had no statistically significant difference (χ2=1. 07,P>0. 05). The incidences of a transient high intraocular pressure,TRD and NVG between the two groups had no statistically significant difference (χ2=0. 69,0. 22,2. 07;all at P>0. 05). The change of CRT from one week to one month after the operation in conbercept injection group was more remarkablethan that in the control group,and the difference was statistically significant (t=-3. 23,P<0. 05). The mean LogMAR BCVA in two groups at 1 month and 6 months after operation were both improved in different degrees compared with the preoperative vision. The difference of mean LogMAR BCVA at 6 months was statistically significant (P<0. 05). Conclusions The intravitreal injection of conbercept during VRS in severe PDR patients can effectively prevent postoperative early VH,decrease CRT and improve visual acuity.
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