在增殖性糖尿病视网膜病变中进行玻璃切除术的手术前抗VEGF的时间:对大型队列的竞争风险分析
Jinlian Zhan1, Gangan Sun1, Haichun Li1
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
Ophthalmology. Retina
|December 31, 2025
概括
针对多发性糖尿病视网膜病变 (PDR) 进行玻璃切除术之前的手术前抗VEGF治疗可以减少玻璃体出血 (VH),但不能减少拉力视网膜脱落 (TRD). 最佳时间是注射后4-7天,以尽量减少复发风险.
科学领域:
- 眼科医生 眼科 眼科
- 视网膜外科手术 视网膜外科手术
- 糖尿病视网膜病变的治疗方法
背景情况:
- 扩散性糖尿病视网膜病变 (PDR) 经常需要进行玻璃切除术.
- 抗血管内皮生长因子 (抗VEGF) 疗法用于手术前.
- 在PDR玻璃切除术之前,抗VEGF治疗的最佳时间尚不清楚.
研究的目的:
- 评估术前抗VEGF治疗时间对术后玻璃体出血 (VH) 和拉力视网膜脱落 (TRD) 风险的影响.
- 为了确定PDR玻璃切除术的最佳注射至手术间隔.
主要方法:
- 对608只接受PDR玻璃切除术的眼睛进行了回顾性队列研究.
- 患者按手术前的抗VEGF治疗 (没有预治疗与抗VEGF) 分组.
- 基于注射到手术间隔 (1-3, 4-7, 8-14, >14天) 分析了抗VEGF组.
- 考克斯的比例危险和竞争风险模型分析了复发时间 (VH或TRD).
主要成果:
- 手术前的抗VEGF治疗与手术后的VH事件较少相关,但没有降低TRD风险.
- 4-7天的注射到手术间隔显示了最低的整体复发率 (VH+TRD).
- 超过14天的间隔与最高的TRD风险有关.
- 视力敏度的结果没有受到注射时间的显著影响.
结论:
- 在PDR玻璃切除术中,术前抗VEGF治疗的好处是并发症特异性,减少VH但不是TRD.
- 4-7天的注射至手术间隔与最低的术后复发率有关.
- 将手术推迟到注射后14天后,会增加TRD的风险.
- 抗VEGF注射的时间是PDR手术规划的关键因素.
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