| Objective:The purpose of this study was to observe the clinical efficacy of preoperative vitreous injection of anti-Vascular Endothelial Growth Factor(Anti-VEGF)drugs combined with 25G standard three-channel Pars Plana Vitrectomy(PPV)on Proliferative Diabetic Retinopathy(PDR)accompanied with Diabetic Macular Edema(DME).we evaluated the changes of BCVA、central macular thickness(CMT)、foveal avascular zone(FAZ)and macular vessel density(VD)at different level before and after the treatment thus to explore the efficacy and safety of anti-VEGF drugs combined with PPV in the treatment of PDR-DME,as well as the effects of vessel density in the macular area on patients’ visual quality.Methods:This is a restrospective research.Patients who were diagnosed with PDR-DME and underwent PPVsurgery in the Second People’s Hospital of Yunnan Province from August 2019 to August 2020 were included in the study.Before surgery,the binocular visual acuity,intraocular pressure,anterior and posterior segment examination under slit lamp,B-ultrasound of the eye and fundus photography were improved in all patients.The OCT and OCT A were used to measure the CMT,FAZ,the VD of Superficial retinal capillary plexus(SCP)and Deep retinal capillary plexus(DCP).Fluorescence fundus angiography(FFA)was performed in patients without contraindication.Patients were divided into groupA and groupB according to whether they received preoperative vitreous injection of anti-VEGF drugs.Among them,56 eyes of 51 cases in group A underwent 25G PPV +pan-retinal photocoagulation+peeling+sterilized air filling+Phaco+IOL implantation;59 eyes of 53 cases in group B were all performed intravitreal injection of 0.05ml of anti-VEGF drug(Conbercept Ophthalmic Injection)three days before the surgery,and 25G PPV+pan-retinal photocoagulation+peeling+sterilized air filling+ Phaco+IOL implantation.All patients took a head-down posture or a face-down prone position for 1 week after the surgery,followed up closely for 6 months in the outpatient.The BCVA and CMT at 1 week,1 month,3 months,and 6 months after the surgery,the FAZ and the average vessel density of SCP and DCP at 6 months after the surgery were recorded respectively.SPSS22.0 statistical system was used to perform statistical analysis on the collected patient data.Results:1.The average vessel density of SCP and DCP of the two groups increased compared to preoperative,and the difference was statistically significant(PA,B<0.05).The change was more obvious in the anti-VEGF combined PPV group(Group B)compared with the PPV group(Group A),the difference is statistically significant(P<0.05).2.The FAZ of Group A at 6 months after the surgery did not change significantly compared with that before the surgery,There was no significant difference(PA>0.05).The FAZ of Group B at 6 months after operation decreased compared with that before operation,The difference was statistically significant(PB<0.05).The difference between the two groups was statistically significant(P<0.05)3.The postoperative CMT of the two groups was significantly reduced compared with that before the surgery,and the macular edema was reduced.The differences were statistically significant(PA,B<0.05).There were significant statistical differences in the CMT change between the two groups at 1 week after the surgery(PA,B<0.05),there was no significant difference in the CMT changes between the two groups at 6 months after surgery(P>0.05).4.The postoperative BCVA of the two groups was significantly improved compared with that before the surgery,and the difference was statistically significant(PA,B<0.05),but the difference between the two groups was not statistically significant(P>0.05).Conclusion:Anti-VEGF combined with PPV have a definite effect in the treatment of proliferative diabetic retinopathy with macular edema,which can effectively improve the best corrected visual acuity of PDR-DME patients,significantly reduce macular edema,improve retinal ischemia and hypoxia,and reduce FAZ of the macula.Combined therapy is better than surgery alone. |
PDF Full Text Request