贝伐单抗辅助的23G玻璃体切割术治疗严重增生性糖尿病视网膜病变的疗效观察

目的：2011年，我国糖尿病患者人数高达9240万。糖尿病视网膜病变（diabeticretinopathy，DR）作为糖尿病患者的常见并发症，在糖尿病人群中的患病率为37％，是导致成人获得性盲的最主要原因之一。严重增生性糖尿病视网膜病变以牵拉性视网膜脱离、玻璃体出血为特征，具有致盲率大，手术难度高等特点。针对与此，本文主要探讨术前注射贝伐单抗对23G玻璃体切割手术治疗严重增生性糖尿病视网膜病变患者效果的影响。方法：回顾性病例对照研究。共收集严重增生性糖尿病视网膜病变患者70例，药物辅助手术组（A组）21例，术前3—7天行玻璃体腔注射贝伐单抗（1．25mg／O．05mL）；单纯手术组（B组）49例，行23G玻璃体切割术。分析两组术前及术后视力、手术时间、医源性裂孔、电凝、术后出血的不同。结果：在术后3月，两组视力提高有统计学意义（P〈O．05）。A组平均手术时间为74分钟，而B组平均手术时间为85分钟（P〉0．05）。医源性裂孔在A组中有1例，而B组中有16例（P〈0．05），在A组中有3例使用电凝，B组中有25例使用电凝（P〈0．05）。A组有1例出现术中及术后出血，B组为20例（P〈O．05）。结论：在这个回顾性研究中，我们发现对于严重增生性糖尿病视网膜病变的病人，术前玻璃体腔注射1．25mg／O．05ml贝伐单抗可以显著减少医源性裂孔的发生，减少术中电凝使用及术中术后出血的发生。

A Therapeutic Effect observation of 23 G Pars Plana Vitrectomy Assisted by Bevacizumab for Severe Proliferative Diabetic Retinopathy

Objective： In 2011, the number of diabetics in China is up to 92.4 million. As a common complication of diabetes, Di- abetic retinopathy （DR, diabetic retinopathy） has become one of the major causes of adult acquired blindness and its prevalence was 37% in the diabetic population. Traction retinal detachment and vitreous hemorrhage are the Characteristic pathophysiological process of Pro- liferative diabetic retinopathy which is known as high blinding rate and high difficulty of operation, In the present study, the effect of preoperative intravitreal bevacizumab injection （IVB） 3-7 days before 23 G pars plana vitrectomy （PPV） for severe proliferative diabetic retinopathy patients was evaluated. Methods： To retrospect and study the cases. 70 patients 70 eyes with severe proliferative diabetic retinopathy who were divided into group A （23 G pars plana vitrectomy assisted by preoperative intravitreal bevacizumab injection, 21 patients 21 eyes） and group B （23G pars plana vitrectomy,49 patients 49 eyes）. Main outcomes measures were visual acuity, operation time, incidence of iatrogenic retinal breaks, endodiathermy, and postoperative bleeding. Results： At 3 months after surgery, the visual acuity of both group improved significantly （P〈0.05）. The average operation time is 74 minutes and 85 minutes in group A and group B respectively（P〉0.05）, Iatrogenic retinal breaks were reported in 1 case in group A and 16 cases in group B （P〈0.05）. Endodiathermy was employed in 3 cases in group A and 25 cases in group B （P〈0.05）. Postoperative bleeding was reported in 1 case in group A while 20 cases were reported in group B （P〈0.05）. Coulusion： In our 70 severe proliferative diabetic retinopathy patients included retrospective study, we found that preoperative intravitreal 1.25 rag/0.05 ml of bevacizumab injection 3-7 days before surgery had a significant effect to the 23 G three channel pars plana vitrectomy： it could reduce the incidence of iatrogenic retinal break and postoperative bleeding, the em- ployment of endodiathermy.