重度非增生型糖尿病视网膜病变患者经抗VEGF联合全视网膜激光光凝术治疗后黄斑水肿转归与术前糖化血红蛋白水平的关系

目的探讨重度非增生型糖尿病视网膜病变(NPDR)患者经抗VEGF联合全视网膜激光光凝术(PRP)治疗后黄斑水肿(DME)转归与术前糖化血红蛋白(HbA1c)水平的关系。方法连续收集2020年4月至2021年6月在郑州大学第一附属医院眼科就诊的41例(79眼)重度NPDR患者的相关资料。根据患者HbA1c水平分为4组:A组11例(21眼),患者HbA1c≤6.5%;B组10例(19眼),患者HbA1c>6.5%~8.0%;C组10例(20眼)患者HbA1c>8.0%~9.0%;D组10例(19眼),患者HbA1c>9.0%。所有患者眼内先行注射康柏西普0.05 mL,术后1周内接受常规532 nm氩绿激光PRP治疗。康柏西普的眼内注射频次为每月1次,共3次。所有患眼均行黄斑部OCT检查,记录术前及术后1周、1个月、3个月患眼黄斑中心凹厚度(CMT)、平均黄斑区视网膜厚度(CAT)及黄斑部体积(CV)。应用两因素重复测量资料的方差分析,分析4组患者间及不同时间CMT、CAT、CV的差异。结果经两因素重复测量资料的方差分析,结果显示,术前不同HbA1c水平和不同时间的交互作用对患者的CMT、CAT、CV的影响均有统计学意义(均为P<0.05)。术前,4组患者CMT、CAT、CV比较差异均无统计学意义(均为P>0.05);术后1周,A组、B组、C组患者CMT、CAT、CV均较术前下降(均为P<0.05),且随着术前HbA1c水平的增高,下降幅度减小;术后1周,D组患者CMT、CAT、CV与术前相比,差异均无统计学意义(均为P>0.05);术后1个月、3个月,4组患者CMT、CAT、CV均较术前明显下降,差异均有统计学意义(均为P<0.05)。结论抗VEGF联合PRP治疗后重度NPDR患者DME的转归与患者术前HbA1c水平关系密切,HbA1c水平越低,治疗效果越好,HbA1c水平越高,术后DME的消退效果越差。

Relation of diabetic macular edema outcome & preoperative glycosylated hemoglobin level in patients with severe non-proliferative diabetic retinopathy after anti-vascular endothelial growth therapy

Objective　To investigate the relationship between the diabetic macular edema (DME) outcome and the preoperative glycosylated hemoglobin (HbA1c) level in patients with severe non-proliferative diabetic retinopathy (NPDR) after anti-vascular endothelial growth factor (VEGF) therapy combined with panretinal photocoagulation (PRP). Methods　A total of 41 patients (79 eyes) with severe NPDR who received treatment at the Ophthalmology Department of the First Affiliated Hospital of Zhengzhou University from April 2020 to June 2021 were divided into four groups according to the HbA1c level: Group A: 11 patients (21 eyes) with HbA1c≤6.5%; Group B: 10 patients (19 eyes) with 6.5%9.0%. All eyes were injected with 0.05 mL of conbercept for three months, once a month before the operation and then received conventional 532 nm argon green laser PRP within a week after the operation. All eyes were checked by macular OCT. The central macular thickness (CMT), central average thickness (CAT), and central volume (CV) were recorded before the operation, one week, one month and three months after the operation. The differences in CMT, CAT and CV at different times among the four groups were analyzed by a two-way repeated measures ANOVA. Results　The effects of preoperative HbA1c levels and interactions at different times on CMT, CAT and CV were statistically significant (all P<0.05). There were no significant differences in CMT, CAT and CV among the four groups before the operation (all P>0.05). Compared with those before the operation, CMT, CAT and CV of patients in groups A, B and C all decreased in the first week after the operation (all P<0.05), and the decrease slowed down with the increase of the preoperative HbA1c level. Compared with those before the operation, there were no significant differences in CMT, CAT and CV in group D in the first week after the operation (all P>0.05). Among the four groups, CMT, CAT and CV in the first and third month after the operation were significantly lower than those before the operation (all P<0.05). Conclusion　The DME outcome of patients with severe NPDR after the anti-VEGF therapy combined with PRP is closely related to the preoperative HbA1c level. The lower the preoperative HbA1c level is, the better the postoperative DME outcome is. The higher the preoperative HbA1c level is, the worse the postoperative DME outcome is.