不同时机玻璃体腔注射康柏西普治疗糖尿病视网膜病变的疗效分析

Efficacy Analysis of Different Timing Intravitreal Injection of Conbercept in the Treatment of Diabetic Retinopathy

摘要: 目的：探究不同时机玻璃体腔内注射康柏西普治疗糖尿病视网膜病变的临床效果，同时分析DR患者预后影响因素。方法：对确诊的65例DR患者的65眼资料进行前瞻性分析。根据基线CMT的大小分为两组，CMT ≤ 360 μm的16眼为轻度ME组，CMT > 360 μm的49眼为重度ME组。将轻度ME组内的患者按随机数字表法分为A组(接受激光光凝后康柏西普玻璃体腔注射，8例8眼)、B组(接受康柏西普玻璃体腔注射后激光光凝，8例8眼)；将重度ME组内的患者按随机数字表法分为C组(接受激光光凝后康柏西普玻璃体腔注射，20例20眼)、D组(接受康柏西普玻璃体腔注射后激光光凝，29例29眼)。治疗完毕后随访6 mo，分别在治疗完毕后1 wk、1 mo、3 mo、6 mo检查患者的最佳矫正视力(best corrected visual acuity, BCVA)、CMT、眼压、DME复发率、不良反应及激光光凝和抗VEGF治疗情况等。结果：在治疗前，四组患者BCVA和CMT均无差异(P > 0.05)。四组患者，治疗后1 wk，1、3、6 mo，BCVA、CMT 均较治疗前改善(P < 0.05)。重度ME组：D组患者术后1 wk，1、3、6 mo BCVA改善均优于C组(P < 0.05)，且D组患者术后BCVA改善趋势优于C组(P < 0.05)；治疗后不同时间D组患者CMT较基线改善情况均优于C组(P < 0.05)，但两组之间CMT改善趋势，差异无统计学意义(P > 0.05)。轻度ME组：A组与B组患者术后BCVA改善及改善趋势相比较，差异均无统计学意义(P > 0.05)；A组与B组患者术后CMT较基线改善情况及CMT改善趋势，差异均无明显统计学差异意义(P > 0.05)。治疗前后四组患者眼压均无明显变化(P > 0.05)，不同时机康柏西普玻璃体腔内注射联合激光光凝治疗基本不会导致患者眼压的波动。B、D组患者激光参数均低于A、C组(P < 0.05)，先行玻璃体药物注射后再行视网膜激光光凝可以降低激光光凝的能量等激光参数。B组患者和D组患者玻璃体腔康柏西普注射次数及激光次数略低于A、C组，但数据未呈现出统计学意义(P > 0.05)。随访期间，四组患者并发症发生率无统计学差异；B、D组患者DME复发率略低于A、C组，但差异无统计学意义。结论：DR患者先行玻璃体腔内注射抗VEGF药物后激光光凝优于激光光凝后行抗VEGF药物玻璃体腔内注射，前者可减少激光光凝能量等激光参数，从而减少对视网膜的损害，且对于重度ME先行玻璃体腔内注药后激光光凝对DR患者视力及黄斑水肿改善更明显，其对患者视力及CMT的改善趋势也优于激光光凝后玻璃体腔内注药。此外，先行玻璃体腔内药物注射后激光光凝有望减少注药次数及激光次数。同时安全性肯定。

Abstract: Objective: To explore the clinical effect of intravitreal injection of Conbercept at different times in the treatment of diabetic retinopathy, and to analyze the prognostic factors of DR patients. Methods: The data of 65 eyes of 65 confirmed DR patients were prospectively analyzed. According to the size of the baseline CMT, they were divided into two groups, 16 eyes with CMT ≤ 360 μm were mild ME group, and 49 eyes with CMT > 360 μm were severe ME group. The patients in mild ME group were randomly divided into group A (receiving intravitreal injection of Conbercept after laser photocoagulation, 8 cases with 8 eyes) and group B (receiving laser Photocoagulation after intravitreal injection of Conbercept, 8 cases with 8 eyes); the patients in the severe ME group were randomly divided into group C (receiving intravitreal injection of Conbercept after laser photocoagulation, 20 cases with 20 eyes), group D (receiving laser Photocoagulation after intravitreal injection of Conbercept, 29 cases with 29 eyes). The patients were followed up for 6 mo after treatment, and the best corrected visual acuity (BCVA), CMT, intraocular pressure, DME recurrence rate, adverse reactions, laser photocoagulation and Anti-VEGF therapy, etc were checked at 1 wk, 1 mo, 3 mo, and 6 mo after treatment. Results: Before treatment, there were no differences in BCVA and CMT among the four groups (P > 0.05). In the four groups, 1 wk, 1, 3, and 6 mo after treatment, BCVA and CMT were all improved compared with those before treatment (P < 0.05). Severe ME group: The improvement of BCVA in group D was better than that in group C at 1 wk, 1, 3, and 6 mo after operation (P < 0.05), and the improvement trend of BCVA in group D was better than that in group C (P < 0.05). The improvement of CMT in group D was better than that in group C at different times (P < 0.05), but there was no significant difference in CMT between the two groups (P > 0.05). Mild ME group: There was no significant difference in postoperative BCVA improvement and improvement trend between group A and group B (P > 0.05); postoperative CMT improvement and trend of CMT improvement between group A and group B after operation, the difference was not statistically significant (P > 0.05). There was no significant change in the intraocular pressure of the four groups before and after treatment (P > 0.05). The intravitreal injection of Conbercept combined with laser photocoagulation at different timings basically did not cause the fluctuation of the intraocular pressure of the patients. The laser parameters of patients in groups B and D were lower than those in groups A and C (P < 0.05). First vitreous drug injection and then retinal laser photocoagulation can reduce laser parameters such as laser photocoagulation energy. The times of intravitreal Conbercept injections and laser times of patients in group B and group D were slightly lower than those in groups A and C, but the data did not show statistical significance (P > 0.05). During the follow-up period, there was no significant difference in the incidence of complications among the four groups; the recurrence rate of DME in groups B and D was slightly lower than that in groups A and C, but the difference was not statistically significant. Conclusion: In DR patients, intravitreal injection of anti-VEGF drugs followed by laser photocoagulation is superior to laser photocoagulation followed by intravitreal injection of anti-VEGF drugs, which can reduce laser parameters such as laser photocoagulation energy, and reduce damage to the retina. The visual acuity and macular edema of DR patients were improved more obviously by laser photocoagulation after intravitreal injection of ME first, and the improvement trend of visual acuity and CMT was also better than that of intravitreal injection after laser photocoagulation. In addition, laser photocoagulation after intravitreal drug injection is expected to reduce the number of drug injections and the number of lasers. At the same time safety is certain.