IVR+PRP联合PPV治疗PDR对患者眼表功能、屈光状态及肾功能的影响

董泽英; 杨青青; 潘艳; 陈志萍; 李新

doi:10.16766/j.cnki.issn.1674-4152.003458

IVR+PRP联合PPV治疗PDR对患者眼表功能、屈光状态及肾功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003458

1.
蚌埠市第二人民医院眼科，安徽蚌埠 233000
2.
蚌埠医科大学第一附属医院内分泌科，安徽蚌埠 233004
3.
蚌埠医科大学第一附属医院肾病科

基金项目:

安徽省科学研究重点项目 2023AH051936

详细信息

通讯作者:
李新，E-mail：469486249@qq.com

中图分类号: R587.2
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出版历程
- 收稿日期: 2023-11-08
- 网络出版日期: 2024-05-29

Clinical effect of IVR+PRP combined with PPV on ocular surface function, refractive status and renal function in patients with proliferative diabetic retinopathy

1.
Department of Ophthalmology, the Second People's Hospital of Bengbu, Bengbu, Anhui 233000, China

摘要

摘要: 目的观察微创玻璃体切割手术(PPV)辅助雷珠单抗玻璃体腔注射(IVR)+全视网膜激光光凝(PRP)治疗增生性糖尿病视网膜病变(PDR)对患者眼表功能、屈光状态、肾功能的影响，为PDR诊疗方案提供参考。方法选取2021年4月—2023年6月蚌埠市第二人民医院眼科收治的伴有轻度玻璃体积血的PDR患者103例，按照病历记录的治疗方案将患者分为激光组(62例)和联合组(41例)。激光组采用IVR联合PRP治疗，联合组在激光组基础上行PPV治疗。治疗前后比较2组患者泪膜功能[泪膜破裂时间(BUT)、泪液分泌检测(SIT)、中央角膜知觉]、房水VEGF水平、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)、屈光状态变化值、糖化血红蛋白(HbA1c)、尿微量白蛋白(mAlb)水平及并发症发生情况。结果治疗后3个月，2组患者BUT、SIT高于治疗前，CMT、BCVA、屈光状态变化值、HbA1c、尿mAlb水平均低于治疗前，且联合组BUT及中央角膜知觉均高于激光组，CMT、BCVA、屈光状态变化值、HbA1c、尿mAlb水平均低于激光组，差异均有统计学意义(P＜0.05)。治疗后7 d，2组患者房水VEGF水平低于治疗前，且联合组[(107.57±24.18)pg/mL]低于激光组[(184.38±30.25)pg/mL]，t=14.325，P < 0.001。联合组并发症发生率低于激光组(P=0.041)。结论 IVR+PRP基础上行PPV术治疗伴有轻度玻璃体积血的PDR，不影响患者眼表功能的稳定性，并可进一步改善患者视力和屈光状态，减轻水肿，降低房水VEGF水平，对肾功能损害小且并发症发生率低，值得临床推广应用。
- 糖尿病视网膜病变 /
- 增生性 /
- 玻璃体切割术 /
- 眼表功能
Abstract: Objective To observe the effects of pars plana vitrecto (PPV) assisted intravitreal ranibizumab (IVR) + pan-retinal photocoagulation (PRP) on ocular surface function, refractive status and renal function of patients with proliferative diabetic retinopathy (PDR), and to provide reference for the diagnosis and treatment of PDR. Methods A total of 103 patients with mild vitreous hemorrhage due to PDR were selected and divided into laser group (n=62) and combined group (n=41), according to their recorded treatment plans at Ophthalmology Department of the Second People's Hospital of Bengbu from April 2021 to June 2023. The laser group received IVR along with PRP, whlie the combined group underwent PPV in addition to the laser group. Before and after treatment, various parameters including tear film function [breakup time of tear film (BUT), Schirmer Ⅰ test (SIT), central corneal perception], VEGF level in fluid, central macular thickness (CMT), best corrected visual acuity (BCVA), refractive change, glycosylated hemoglobin (HbA1c), urinary microalbumin (mAlb) level and complications were detected and compared between the 2 groups. Results After 3 months of treatment, BUT and SIT values were increased in both groups, whlie CMT, BCVA, refractive change value, HbA1c level, and urinary mAlb level were decreased. Furthermore, BUT and central corneal perception in the combined group were higher than those in the laser group. On the other hand, CMT, BCVA, refractive status change, HbA1c level, and urinary mAlb level in the combined group were all significantly lower than those in the laser group (P < 0.05). After 7 days of treatment, VEGF level in aqueous fluid decreased in both groups. However, it was significantly lower in the combination group [(107.57±24.18) pg/mL] compared to that in the laser group [(184.38±30.25) pg/mL, t=14.325, P < 0.001]. The complication rate of the combination group was significantly lower than that of the laser group (P=0.041). Conclusion The additional PPV treatment, based on IVR+PRP, for PDR with mild vitreous hemorrhage does not impact the stability of ocular surface function. Moreover, it improves the visual acuity and refractive status in patients while alleviating edema and reducing the VEGF levels in aqueous humor. Furthermore, this treatment has minimal renal damage and low incidence of complications, making it highly suitable for clinical promotion and application.
- Diabetic retinopathy /
- Hyperplasia /
- Vitrectomy /
- Ocular surface function

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表 1 2组PDR患者治疗前后泪膜功能比较(x ± s)

Table 1. Comparison of tear film function between the two groups of PDR patients before and after treatment(x ± s)

组别	例数	BUT(s)			SIT(mm)			中央角膜知觉(mm)
组别	例数	治疗前	治疗后7 d	治疗后3个月	治疗前	治疗后7 d	治疗后3个月	治疗前	治疗后7 d	治疗后3个月
联合组	41	6.53±1.02	5.67±1.28^a	10.33±1.43^ab	5.58±1.56	6.07±1.32	8.56±1.22^ab	37.73±11.32	36.33±9.16^a	39.41±3.25^ab
激光组	62	6.47±1.23	5.89±1.33^a	9.12±1.45^ab	5.69±1.48	6.32±1.41^a	7.17±1.31^ab	37.18±12.07	37.55±8.74	37.32±3.43
F值		0.263	0.864	4.162	0.372	0.885	5.865	0.255	0.672	3.199
P值		0.664	0.383	< 0.001	0.609	0.396	< 0.001	0.807	0.508	0.002
注：与同组治疗前比较，^aP < 0.05;与同组治疗后7 d比较，^bP < 0.05。

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表 2 2组PDR患者治疗前后房水VEGF水平比较(x ± s，pg/mL)

Table 2. Comparison of VEGF levels in aqueous humor between the two groups of PDR patients before and after treatment(x ± s, pg/mL)

组别	例数	治疗前	术后7 d
联合组	41	335.71±82.62	107.57±24.18^b
激光组	62	322.82±83.18	184.38±30.25^b
统计量		0.772^a	14.325^c
P值		0.442	< 0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP < 0.05。

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表 3 2组PDR患者治疗前后CMT、BCVA及屈光状态变化值比较(x ± s)

Table 3. Comparison of CMT, BCVA and refractive status changes between the two groups of PDR patients before and after treatment(x ± s)

组别	例数	CMT(μm)		BCVA(logMAR)		屈光状态变化值
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
联合组	41	412.33±34.22	227.57±24.18^b	1.53±0.24	0.54±0.11^b	-0.48±0.19	-1.43±0.25^b
激光组	62	411.72±32.11	267.38±30.25^b	1.54±0.22	0.72±0.10^b	-0.45±0.17	-0.78±0.22^b
统计量		0.092^a	8.602^c	0.218^a	8.772^c	0.836^a	14.689^c
P值		0.927	< 0.001	0.828	< 0.001	0.405	< 0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP < 0.05。

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表 4 2组PDR患者治疗前后HbA1c、mAlb水平比较(x ± s)

Table 4. Comparison of HbA1c and mAlb levels between the two groups of PDR patients before and after treatment(x ± s)

组别	例数	HbA1c(%)		mAlb(mg/dL)
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月
联合组	41	8.47±1.25	6.23±0.96^b	2.14±0.21	1.62±0.28^b
激光组	62	8.36±1.42	7.53±1.09^b	2.21±0.27	1.98±0.23^b
统计量		0.403^a	7.109^c	1.402^a	7.828^c
P值		0.688	< 0.001	0.164	< 0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP < 0.05。

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