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目的:增生性糖尿病性视网膜病播散性视网膜激光光凝后,用非选择性抗VEGF抑制剂贝伐单抗治疗糖尿病性黄斑水肿,调查患者自我评估的视功能及视力。方法:30例30眼增生性糖尿病性视网膜病伴持续性糖尿病性黄斑水肿连续病例,播散性视网膜激光光凝后,1.25mg贝伐单抗0.05mL (Avastin)单剂量玻璃体腔注射治疗。对照组包括30例30眼增生性糖尿病性视网膜病,只接受播散性视网膜激光光凝。主要的调查结果包括Snellen视力,眼底临床检查和患者自我用0-100分数值范围评价的视觉质量。结果:贝伐单抗组的平均基线视力为0.48±0.58 logMAR,对照组为0.61±0.78 (两组无显著差异)。6mo后,视力没有显著的变化,贝伐单抗组和对照组分别为0.33±0.41和0.52±0.68。临床检查显示黄斑水肿仅有一些改善趋势。患者用直观模拟标度尺主观评价视功能结果显示注射贝伐单抗6mo后由60.2±17.5改善至76.0±15.6 (P<0.001)。对照组自我评估视功能平均值为59.6±19.8,与贝伐单抗组基线值无显著差异,但是低于注射贝伐单抗后分数,差异有高度显著性(P<0.01)。结论:治疗增生性糖尿病性视网膜病的黄斑水肿,贝伐单抗(Avastin)玻璃体腔注射作为播散性激光光凝的辅助治疗较单纯的激光治疗后患者满意度和自我评价的视力显著改善。患者视力在6mo后无明显变化。
AIM: Proliferative diabetic retinopathy disseminated retinal laser photocoagulation, non-selective anti-VEGF inhibitor bevacizumab treatment of diabetic macular edema, self-assessment of patients with visual function and visual acuity. Methods: Thirty consecutive patients with proliferative diabetic retinopathy with persistent diabetic macular edema were treated with one dose of Avastin (1.25 mg) and 1.25 mg of Avastin after disseminated retinal laser photocoagulation. The control group consisted of 30 patients with 30 eyes of proliferative diabetic retinopathy and received only disseminated retinal laser photocoagulation. The main findings include Snellen Vision, Fundus Clinics and Patient Self with a visual quality rating of 0-100 points. RESULTS: The mean baseline visual acuity of bevacizumab was 0.48 ± 0.58 logMAR in the control group and 0.61 ± 0.78 in the control group (no significant difference between the two groups). There was no significant change in visual acuity after 6 months. Bevacizumab and control groups were 0.33 ± 0.41 and 0.52 ± 0.68, respectively. Clinical examination showed only some improvement in macular edema. Patients subjectively evaluated visual function using a visual analog scale and the results showed improvement from 60.2 ± 17.5 to 76.0 ± 15.6 (P <0.001) after 6 months of bevacizumab injections. The mean value of self-assessment in control group was 59.6 ± 19.8, which was significantly lower than that of bevacizumab group, but lower than that of bevacizumab group (P <0.01). Conclusions: The treatment of proliferative diabetic retinopathy with macular edema and Avastin intravitreal injection as a adjunct to disseminated laser photocoagulation significantly improves patient satisfaction and self-assessment of vision after laser treatment alone. The patient’s visual acuity did not change significantly after 6 months.