老年医学研究

目的对比单纯激光治疗与激光联合抗血管内皮生长因子(VEGF)治疗对老年糖尿病性黄斑水肿(DME)的效果,探讨抗VEGF药物治疗糖尿病视网膜病变的作用机制。方法选取就诊于我院的60岁以上DME患者113例113只眼,根据治疗方式不同分为联合组59例59只眼、激光组54例54只眼。联合组采用玻璃体腔注射抗VEGF药物雷珠单抗1周后进行视网膜光凝治疗;激光组仅给予视网膜光凝治疗。随访6个月,比较两组治疗前、治疗后6个月时最佳矫正视力(BCVA)、中心凹厚度(CFT)、微动脉瘤(MA)数量、视网膜新生血管面积(RNA)及硬性渗出(HE)面积的变化。结果治疗后6个月时,联合组BCVA、CFT、MA、RNA均低于激光组(P均<0.05)。治疗后6个月时,激光组MA及RNA均低于同组治疗前,联合组BCVA、CFT、MA、RNA均低于同组治疗前(P均<0.05)。结论与单纯激光治疗相比,抗VEGF联合激光治疗可以明显提高老年DME患者视力,改善眼底情况。抗VEGF药物玻璃体腔内注射可以在形态学及功能学上逆转糖尿病所导致的视网膜改变。

Objective al growth factor(VEGF)on diabetic macular edema(DME)in elderly population,and explore the mechanism of antiVEGF in the treatment of diabetic retinopathy.Methods were selected. According to different treatment methods,59 eyes were divided into combined group(n=59),and 54 eyes were divied into laser group(n=54). In the combined group,retinal photocoagulation therapy was performed 1 week after intravitreal injection of Ranibizumab. In the laser group only treated with retinal photocoagulation. The patients were followed up for 6 months,and the changes of the best corrected visual acuity(BCVA),central foveal thickness(CFT),microneurysm(MA),retinal neovascularization area(RNA)and hard exudates(HE)were compared between the two groups,before and after 6 months.Results group were all lower than those in the laser group(all P <0. 05). Within the group,6 months after treatment,the number of MA and RNA in the laser group were lower than before treatment,and BCVA,CFT,MA and RNA in the combination group were lower than before treatment(all P <0. 05).Conclusion anti-VEGF combined with laser treatment is more significant,which can significantly improve the visual acuity and the condition of the fundus of patients. Intravitreous injection of anti-VEGF drugs can reverse the retinal changes caused by diabetes in terms of morphology and function.