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目的研究25+微创玻璃体视网膜手术(VRS)联合玻璃体腔注射雷珠单抗(IVR)治疗增生型糖尿病视网膜病变(PDR)的效果。方法选取行25+微创VRS患者88例(88眼),分为治疗组(n=44)和对照组(n=44)。治疗组术前3~5 d予以IVR治疗后行25+微创VRS;对照组仅行25+微创VRS。比较两组患者术中情况、最佳矫正视力(BCVA)、眼压及术后并发症情况。结果治疗组患者的手术时间、电凝次数、医源性裂孔发生率、玻璃体腔硅油填充率均低于对照组(P<0.05);术后两组患者BCVA均高于术前(P<0.05),术后两组患者眼压均低于术前(P<0.05);术后3个月,治疗组患者玻璃体积血发生率、牵拉性视网膜脱离发生率均低于对照组(P<0.05)。结论行25+微创VRS联合IVR可有效缩短手术时间,降低医源性裂孔和玻璃体出血发生率,降低硅油填充率,有助于PDR患者术后视力的恢复。
Objective To study the effect of 25 + minimally invasive vitreoretinal surgery (VRS) combined with intravitreal injection of ranibizumab (IVR) in the treatment of proliferative diabetic retinopathy (PDR). Methods Totally 88 patients (88 eyes) with 25 minimally invasive VRS were divided into treatment group (n = 44) and control group (n = 44). In the treatment group, 25 + minimally invasive VRS was performed after IVR treatment 3 to 5 days before operation, and 25 + minimally invasive VRS in control group. Intraoperative conditions, best corrected visual acuity (BCVA), intraocular pressure and postoperative complications were compared between the two groups. Results The operation time, the number of electrocoagulation, the incidence of iatrogenic hiatus and the filling rate of silicone oil in vitreous cavity in the treatment group were significantly lower than those in the control group (P <0.05). The BCVA in both groups were significantly higher than those before operation (P <0.05) ), Postoperative IOP in both groups were lower than preoperative (P <0.05). At 3 months after operation, the incidences of vitreous hemorrhage and traction retinal detachment were lower in the treatment group than those in the control group (P < 0.05). Conclusion 25 + minimally invasive VRS combined with IVR can shorten the operation time, reduce the incidence of iatrogenic hiatus and vitreous hemorrhage, reduce the filling rate of silicone oil, and help to restore visual acuity after PDR.