康柏西普玻璃体腔注射联合PRP治疗老年增殖性糖尿病视网膜病变疗效及对房水VEGF、视力水平和术后并发症的影响

Efficacy of intravitreal injection of conbercept combined with PRP in treatment of elderly patients with proliferative diabetic retinopathy and its influence on aqueous humor VEGF,visual acuity and postoperative complications

中文关键词: 老年  增殖性糖尿病视网膜病变  康柏西普  全视网膜光凝术  视力水平  房水  血管内皮生长因子

英文关键词: elderly  proliferative diabetic retinopathy  conbercept  panretinal photocoagulation  visual acuity level  aqueous humor  vascular endothelial growth factor

中文摘要:

      目的 探究康柏西普玻璃体腔注射联合全视网膜光凝术(PRP)治疗老年增殖性糖尿病视网膜病变疗效及对房水血管内皮生长因子(VEGF)、视力水平和术后并发症的影响,为治疗该类型病症提供方法.方法 回顾性分析2022年1月-2024年1月成都市第三人民医院接收的366例老年增殖性糖尿病视网膜病变患者的临床资料,按照治疗方案不同分为PRP组与注射组,每组183例(366眼).2组均行PRP治疗,注射组在此基础上于首次PRP前72 h行0.05 mL康柏西普玻璃体腔注射治疗.对比2组手术结束3个月后临床疗效,对比2组术前与术后1、3个月最佳校正视力(BCVA)、黄斑中心凹厚度(CMT)以及眼压(IOP)、术后3个月房水生化指标值[VEGF、基质细胞衍生因子1(SDF-1)]、术后并发症.结果 注射组疗效高于PRP组(89.62％vs81.97％,P＜0.05);2组患者BCVA时间、分组、交互差异均有统计学意义(P＜0.05),且术后1、3个月时,注射组BCVA低于PRP组(P＜0.05);2组CMT时间、分组、交互差异均具有统计学意义(P＜0.05),且术后1、3个月时,注射组CMT低于PRP组(P＜0.05);2组IOP时间、分组差异均有统计学意义(P＜0.05),术后1月、3个月,2组IOP较术前下降(P＜0.05),2组间差异无统计学意义(P＞0.05);术后3个月,注射组房水VEGF、SDF-1水平均低于PRP组(P＜0.05);注射组并发症发生率(19.67％)与PRP组(12.57％)差异无统计学意义(P＞0.05).结论 康柏西普玻璃体腔注射联合PRP可有效治疗老年增殖性糖尿病视网膜病变,提高患者视力,降低CMT,改善房水微环境,安全有效,具有一定的临床应用价值.

英文摘要:

      Objective To investigate the efficacy of intravitreal injection of conbercept combined with panretinal photo-coagulation(PRP)in the treatment of elderly patients with proliferative diabetic retinopathy(PDR)and its influence on aqueous humor vascular endothelial growth factor(VEGF),visual acuity and postoperative complications,and provide a meth-od for the treatment of this disease.Methods The clinical data of 366 elderly PDR patients(366 eyes)admitted to Third People's Hospital of Chengdu City from January 2022 to January 2024 were retrospectively analyzed.They were divided into PRP group and injection group according to different treatment regimens,with 183 cases in each group.Both groups received PRP treatment.The injection group received 0.05 mL intravitreal injection of conbercept at 72 h before the first PRP.The clini-cal efficacy at 3 months after the end of the surgery was compared between the two groups.The best corrected visual acuity(BCVA),central macular thickness(CMT)and intraocular pressure(IOP)before surgery and at 1 month and 3 months after surgery,aqueous humor biochemical indexes[VEGF,stromal cell derived factor 1(SDF-1)]at 3 months after surgery and postoperative complications were compared between the two groups.Results The efficacy in the injection group was signifi-cantly higher than that in the PRP group(89.62％ vs 81.97％,P＜0.05).There were statistically significant differences in BCVA between the two groups in terms of time,grouping,and interaction(P＜0.05).At 1 and 3 months after surgery,the BCVA in the injection group was significantly lower than that in the PRP group(P＜0.05).There were statistically significant differences in CMT between the two groups in terms of time,grouping,and interaction(P＜0.05).At 1 and 3 months after surgery,CMT in the injection group was significantly lower than that in the PRP group(P＜0.05).There were statistically significant differences in IOP between the two groups in terms of time and grouping(P＜0.05).At 1 month and 3 months after surgery,IOP in both groups decreased significantly compared with that before surgery(P＜0.05),but there was no statistically significant difference between the two groups(P＞0.05).At 3 months after surgery,the levels of VEGF and SDF-1 in the aqueous humor in the injection group were significantly lower than those in the PRP group(P＜0.05).There was no statisti-cally significant difference in the incidence of complications between the injection group(19.67％)and the PRP group(12.57％)(P＞0.05).Conclusion Intra vitreal injection of conbercept combined with PRP can effectively treat elderly PDR patients,improve their visual acuity,reduce CMT,and improve the aqueous humor microenvironment.It is safe and effective and has certain clinical application value.