雷珠单抗注射液球内注射治疗糖尿病黄斑水肿与常规治疗方法对比观察

A Comparative Study between Conventional Approaches and Intraocular Injection of Ranibizumab in the Treatment of Diabetic Macular Edema

摘要: 目的：探索更为有效，更为经济便捷的DME治疗手段。方法：分析2012年6月至2016年5月就诊于我院的DME患者经激光、玻璃体腔注射雷珠单抗/曲安奈德、玻璃体切割手术治疗的98例104只眼，其中男56例58只眼，女42例46只眼，平均年龄为57岁。结果：各组治疗前后视力和CMT变化情况：1) 玻璃体腔内注射TA，在治疗1月和3月时，患者视力有显著提高，CMT明显降低，差异有显著性(p = 0.000)；治疗6月视力稍有提高，CMT较治疗前变化不明显，差异无显著性。2) 玻璃体腔内注射雷珠单抗，在治疗1月时视力显著提高，CMT明显降低，差异有统计学意义(p = 0.001)；在治疗3月和6月时，视力略提高，CMT无明显变化，差异无显著性。3) 在接受黄斑区激光光凝和(或)全网膜光凝，视力在治疗1个月时，略下降，差异无显著性；视力在治疗3月和6月时，视力无变化，差异无显著性。CMT在治疗1月和3月时稍减轻，与治疗前无显著性差异；治疗6月时CMT明显减轻，差异有显著性(p = 0.001)。4) 在接受玻璃体切割术治疗1月、3月和6月时，视力均有所提高，差异有显著性(p = 0.001)。CMT在治疗1月时减轻，差异无显著性；在术后3月和6月时，CMT减轻，较治疗前差异有显著性(p = 0.001)。结论：玻璃体腔注射雷珠单抗和注射TA、黄斑区光凝与玻璃体切割术在治疗DME上都是有效的。在提高视力方面，注药和玻璃体切割术更为有效。玻璃体腔注射TA，效果亦较好，但并发白内障、继发青光眼、眼内炎等并发症较多，要权衡治疗效果与风险而慎重选择，对于严重白内障和人工晶体的患者亦不失为一种很好的选择。激光治疗如果作为首选，尽管视网膜水肿可以消退但视力提高不是很明显。玻璃体切割术效果稳定持久，但需要具备特定的手术条件和手术技术，需要掌握好适应症，可以作为治疗黄斑水肿的常见方法。

Abstract: Purpose: The purpose of this research is to uncover a more effective, economical and more conve-nient approach in the treatment of diabetic macular edema (DME). Method: The research is con-ducted by analyzing 98 DME cases with 104 eyes that are treated through laser photocoagulation, intravitreal injection of Ranibizumab, intravitreal injection of triamcinolone (TA) and vitrectomy respectively in the Baotou Eye Hospital from June, 2012 to May, 2016. Among 98 cases with 104 eyes, 56 cases with 58 eyes are male patients while 42 cases with 46 eyes are female patients. The average age of 98 patients are 57. Results: The comparison of eyesight and central macular thick-ness (CMT) before and after treatment with different approaches: 1) In cases that are treated through intravitreal injection of TA, the effectiveness of this approach is significant in the first month and the third month. The eyesight of patients is considerably improved (p = 0.000). More-over, CMT of patients shows a remarkable decrease. However, the effectiveness of TA treatment is no longer significant in the third month and the sixth month. The eyesight of patients is slightly improved and CMT shows no remarkable change. 2) In cases that are treated through intravitreal injection of Ranibizumab, the effectiveness of this approach is statistically significant in the first month and the third month (p = 0.001). The eyesight of patients is considerably improved and CMT shows a remarkable decrease. Similarly, the effectiveness of Ranibizumab is no longer significant in the third month and the sixth month. The eyesight of patients is slightly improved and CMT shows no remarkable change. 3) In cases that are treated through laser photocoagulation in macular region or the whole retinal, the effectiveness of this approach is not significant since the first month. The eyesight of patients is slightly decreased. The effectiveness remained insignificant in the third and sixth month with no remarkable change of eyesight. CMT shows a slight decrease in the first and third month and manifests a statistically significant decrease in the sixth month (p = 0.001). 4) In cases that are treated through vitrectomy, the eyesight of patients is significantly improved in the first, third and sixth month. CMT shows a slight decrease in the first and third month but manifests a significant decrease in the sixth month when compared with the situation before treatment (p = 0.001). Conclusion: Laser photocoagulation, intravitreal injection of Ranibizumab, intravitreal injection of TA and vitrectomy are all effective in the treatment of DME. With respect to eyesight improvement, intravitreal injection and vitrectomy show more significant effectiveness. Although intravitreal injection of TA is considered to be more effective especially for patients with serious cataract or artificial lens when compared with other approaches, the risk of complications of cataract, secondary glaucoma or endophthalmitis is higher. Therefore, it is necessary to balance the effectiveness and potential complications when choosing different approaches. In terms of laser photocoagulation, it is effective to decrease CMT but shows no significant improvement of eyesight. In addition, the effectiveness of vitrectomy is more stable. However, it can only be implemented with specific operation conditions and skills. As a consequence, it can be applied as a conventional approach to treat DME.