【作者】 魏巍；

【导师】 马翔；

【作者基本信息】 大连医科大学 ， 眼科学， 2011， 硕士

【摘要】 目的:观察玻璃体内注射贝伐单抗联合曲安奈德治疗糖尿病性黄斑水肿(diabetic macular edema,DME)的疗效。方法:选取2009年8月~2010年9月我院住院或门诊经临床检查诊断为DME的患者32例,电脑随机分组,分为联合注药组18例20眼,单独注药组14例20眼。联合注药组采用贝伐单抗1.25mg/0.05mL、曲安奈德2mg/0.05mL玻璃体腔联合注射治疗;单独注药组采用曲安奈德2mg/0.05mL玻璃体腔注射治疗。随访观察详细记录视力、黄斑中心视网膜厚度(central maeular thiekness,CMT)、眼压等变化情况。结果:视力各组间进行比较:联合注药组和单独注药组注药后1w LogMAR值分别为:0.57±0.11、0.60±0.54,均有显著改善(t=4.079,P<0.001)、(t=6.496,P<0.001),但组间无显著性差异(t=-0.981,P=0.333);而注药后1m、2m、3m,联合注药组LogMAR值分别为:0.53±0.84、0.48±0.70、0.50±0.73,单独注药组LogMAR值分别为:0.60±0.53、0.60±0.52、0.60±0.87。组间有显著性差异(t=-3.278,P=0.003)、(t=-5.739,P<0.001)、(t=-4.072,P<0.001)。CMT结果显示,注药后1m、2m、3m,联合注药组CMT值分别为:348.33±36.66、356.88±40.73、368.06±40.50;单独注药组CMT值分别为:350.00±27.65、358.82±26.97、369.21±26.18,两组之间进行各时间点比较,无显著性差异(t=-0.161,P=0.873)、(t=-0.178 ,P=0.860)、(t=-0.107,P=0.916),两组治疗后各时间点较治疗前有显著差异(P<0.001)。眼压:治疗后1w、1m、2m、3m联合注药组眼压值分别为:16.62±1.24、16.57±0.91、16.91±1.57、16.79±1.81,单独注药组眼压值分别为:16.69±1.52、16.80±1.16、16.39±0.86、16.66±1.26。注药1w后联合注药组和单独注药组比较眼压无显著性差异:1w(t=-0.144 ,P=0.804)、1m(t=-0.684,P=0.468)、2m(t=1.306,P=0.208)、3m(t=0.265,P=0.474),联合注药组和单独注药组治疗后各时间点较治疗前有显著差异(P<0.001),联合注药组和单独注药组治疗后眼压较治疗前眼压有所升高(≤21mmHg)。单独注药组有5眼在2个月复诊时出现视力再次下降,40眼中有3眼在治疗后第ld有角膜上皮的小片状剥脱,6眼治疗后出现注射部位的小片状结膜下出血,1w后出血吸收。无其他眼科及全身并发症。结论:玻璃体腔注射贝伐单抗联合曲安奈德治疗糖尿病性黄斑水肿疗效明显。玻璃体腔注射贝伐单抗联合曲安奈德是一种安全、可靠、方便、经济的治疗糖尿病性黄斑水肿方法。更多还原

【Abstract】 Objective: To evaluate the clinical effect of intravitreal bevacizumab combined with triamcinolone acetonide in patients with diabetic macular edema (DME).Methods: Thirty-two eyes with DME inpatients or outpatients in our hospital from August 2009 to September 2010 were randomly divided in to Combination injection group of 18 cases with 20 eyes and single injection group of 14 cases with 20 eyes. Combination injection group were treated with intravitreal bevacizumab (1.25mg/ 0.05mL ) , triamcinolone acetonide (2mg/0.05mL ) and the single injection group group received intravitreal triamcinolone acetonide(IVTA 2mg/0.05mL ) alone. The visual acuity of LogMAR, intraocular pressure(IOP),central retinal macular thickness (CMT) by optical coherence tomography(OCT) and the fundus fluorescein angiography (FFA) macular changes were observed and recorded.Results:The Visual acuity of Combination injection group and single injection group were respectively 0.57±0.11、0.60±0.54,had significant difference at a week (t=4.079,P<0.001)、(t=6.496,P<0.001), while there were no statistically significant difference between groups (t=-0.981,P=0.333) ; The difference was statistically significant after injection (1m , 2m, 3m) between the groups (t =- 3.278,P = 0.003), (t =- 5.739,P <0.001), (t =- 4.072,P <0.001),the LogMAR of Combination injection group were:0.53±0.84、0.48±0.70、0.50±0.732,and single injection group were:0.60±0.53、0.60±0.52、0.60±0.87 . CMT results,after injection 1m、2m、3m,the CMT of Combination injection group were:348.33±36.66、356.88±40.73、368.06±40.50;and single injection group were:350.00±27.65、358.82±26.97、369.21±26.18,comparing between each group of two groups: there were no significant difference between the groups(t=-0.161,P=0.873)、(t=-0.178,P=0.860)、(t=-0.107,P=0.916), the CMT were significant difference after treatment between each group respectively(P<0.001).Intraocular pressure: after injection 1w、1m、2m、3m, the intraocular pressure of Combination injection group were:16.62±1.24、16.57±0.91、16.91±1.57、16.79±1.81,and single injection group were:16.69±1.52、16.80±1.16、16.39±0.86、16.66±1.26.comparing each group, the IOP after injection were no significant difference at one week, 1w(t=-0.144,P=0.804)、1m(t=-0.684,P=0.468)、2m(t=1.306, P=0.208)、3m(t=0.265,P=0.474), the IOP were significant difference after treatment between each group respectively(P<0.001).The IOP of combination injection group was superior to the single injection group(≤21mmHg). In the single injection group, the visual acuity of five patients were decreased again in 2 months. Three of forty eyes had little flaky exfoliation in the corneal epithelium at one day after treatment, 6 eyes had small flakes subconjunctival hemorrhage in the injection site after treatment, but was absorbed after 1w. No other ophthalmic and systemic complications.Conclusions:Intravitreal bevacizumab combined with triamcinolone acetonide injection in patients with DME has obvious clinical effect. Intravitreal bevacizumab combined with triamcinolone acetonide injection is a safe, reliable, convenient and economical treatment of diabetic macular edema.更多还原