南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (08): 1207-.

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膜剥离联合玻璃体腔注射贝伐单抗治疗黄斑前膜

李志强,张国明,苏康进,宋湘梅,田汝银,古洵清   

  • 出版日期:2014-08-20 发布日期:2014-08-20

Membrane peeling combined with intravitreal injection of bevacizumab for treatment of
macular epiretinal membrane: analysis of 33 cases

  • Online:2014-08-20 Published:2014-08-20

摘要: 目的探讨膜剥离联合玻璃体腔注射贝伐单抗治疗黄斑前膜的临床效果。方法回顾性,对照研究。2012年1月~2013年6
月选取进行玻璃体手术膜剥离治疗黄斑前膜患者33 例(33 只眼),随机分为玻璃体腔注射贝伐单抗组(IVB组)和非玻璃体腔注
射贝伐单抗组(非IVB组)。所有患者均行标准三切口玻璃体切除,剥除黄斑前膜,IVB组手术结束时玻璃体腔注入贝伐单抗
1.5 mg。患者治疗前后均进行最佳矫正视力、光相干断层成像术检查(optical coherence tomography, OCT)检查。术后随访3~
14个月(平均6.5个月)。收集两组数据,应用SPSS17.0进行统计学分析。结果黄斑前膜均经手术成功剥除,未见眼内感染、出
血等并发症。15只眼进行了玻璃体手术膜剥离联合玻璃体腔贝伐单注射术,18只眼进行了玻璃体手术膜剥离。随访毕,最佳
矫正视力变化IVB组视力提高者11只眼,约占73.3%,非IVB组视力提高者13只眼,约占72.2%,两组比较差异无统计学意义
(P=0.627);中心凹处黄斑厚度变化,IVB组平均降低143±62 μm,非IVB组平均降低96±28 μm,两组比较差异有统计学意义(t=
5.564,P<0.01)。结论玻璃体手术膜剥离联合玻璃体腔注射贝伐单抗有助于黄斑形态结构恢复,但对视功能改善效果不明显,
其在临床推广运用有待于长期大样本随机对照研究。

Abstract: Objective To assess efficacy of membrane peeling combined with intravitreal injection of bevacizumab in the
treatment of macular epiretinal membrane. Methods From January, 2012 to June, 2013, 33 patients (33 eyes) with the diagnosis
of macular epiretinal membrane underwent vitreous surgery and membrane peeling. The patients were randomly divided into
intravitreal bevacizumab group (IVB group) and non-intravitreal bevacizumab group (non-IVB group). All the patients
underwent standard three-port vitrectomy and peeling of epiretinal membrane, with intravitreal injection of 1.5 mg
bevacizumab at the end of operation in IVB group. The best corrected visual acuity and optical coherence tomography (OCT)
were examined before and after the treatment. The patients were followed up for 3-14 months (mean 6.5 months). Results
Macular epiretinal membranes were successfully peeled during operation in all the patients without postoperative intraocular
infection or bleeding. Fifteen eyes received vitrectomy combined with intravitreal injection of bevacizumab, and 18 underwent
only vitreous operation and membrane peeling. At the end of the follow up, the visual acuity improved in 11 eyes (73.3%) in
IVB group, as compared to 13 eyes (72.2%) in the non-IVB group (P=0.627). Central macular thickness decreased by 143±62 μm
in IVB group and by 96±28 μm in non-IVB group, showing a significant difference between the two groups (t=5.564, P<0.01).
Conclusion Vitrectomy and membrane peeling combined with intravitreal injection of bevacizumab can promote the recovery
of macular morphology but not visual function, and its clinical use still needs to be tested in a long-term and large-sample
randomized controlled study.