| Background and Objective:the non-severe proliferative diabetic retinopathy(N-SPDR) is equivalent to the diabetic retinopathy classification of our country 1984,staging criteria of IV(retinal neovascularization and vitreous hemorrhage) and V(retinal neovascularization and fibrous tissue proliferation), if the treatment is not timely or improper, it will soon be developed into the stage of the severe proliferative diabetic retinopathy(SPDR) that cause irreversible damage like tractional detachment of retina, affecting the quality of life in patients with severe vision loss. Formerly, the patients with proliferative diabetic retinopathy(PDR) were treated by vitrectomy combined with laser, also curative effect affirmation; But Ranibizumab(the trade name of Lucentis) as vascular endothelial growth factor(VEGF) inhibitors provides us with the advent of a new thinking and method of the treatment measures for PDR. The Ranibizumab can effectively inhibit the choroid and retinal neovascularization, reducing leakage and hemorrhage; While the most obvious characteristics of the PDR is the retinal neovascularization, resulting vitreous hemorrhage, proliferation of film formation and tractional retinal detachment, although Ranibizumab used in this text is off-label, but also is not in violation of the principle of symptomatic treatment. Here we will study the effect of intravitreal injection of Ranibizumab for vitreous hemorrhage in the non-severe proliferative diabetic retinopathy(N-SPDR). Method:Between April 2013 and June 2014 in my treatment group,that be diagnosed as type 2 diabetes mellitus combine with the non-severe proliferative diabetic retinopathy(N-SPDR),39 eyes of 30 cases of patients with vitreous hemorrhage, 13 cases of male(17 eyes),17 cases of female(22 eyes), age 33 ~ 60 years old(48.53 ± 3.34 years), agreeing to accept the intravitreal injection of Ranibizumab, set to the injection group; The same period,unwilling to accept the intravitreal injection of Ranibizumab, 24 eyes of 17 cases of patients with vitreous hemorrhage, 7 cases of male(10 eyes),10 cases of female(14 eyes), aged 31~ 70 years old(49.17 ± 3.25 years), set to the control group. Before treatment, two groups of patients the best corrected visual acuity comparative statistical analysis, there was no statistically significant difference(2c= 0.2144, P = 0.6434). Observation and record the absorption of vitreous hemorrhage after injection Ranibizumab, treatment measures and effect of following retinal laser and vitrectomy in the injection group; Control group except not accepting injection Ranibizumab, the other treatment and follow-up were with the injection group. The follow-up time was 6~18 months. Results:Six months after Ranibizumab injection, injection group compared with control group the best corrected visual acuity statistical analysis, there was no statistically significant difference( 2c= 2.9759, P = 0.0845). The injection group,before drug injection compared with followed up for 6 months the best corrected visual acuity statistical analysis, the difference was statistically significant(2c= 16.8429, P<0.0001); The control group, preoperative compared with follow-up of 6 months the best corrected vision acuity statistical analysis, the difference was statistically significant(2c= 6.1108, P = 0.0134); When followed up for 6 months, with injection group, a total of 39 eyes, 8 eyes to avoid the vitrectomy, 31 eyes underwent vitrectomy within only 9 eyes choose vitreous filling silicone oil; Control group a total of 24 eyes, all received vitrectomy, 17 eyes filled with silicone oil. For the patients who avoided vitrectomy, 8 eyes(20.51%) in the injection group compared with control group 0 eye, the difference was statistically significant(the correct 2c= 3.9406, P = 0.0471). For the patients who received vitrectomy, the silicone oil filled with in the injection group(29.03%) is lower than the control group(70.83%), the difference was statistically significant(2c= 9.4829, P = 0.0021) Conclusion:1. Intravitreous injection of Ranibizumab for the non- severe proliferative diabetic retinopathy(N-SPDR) patients with vitreous hemorrhage, is safe and effective, it combined with laser can treat portion of patients suffering from N-SPDR to avoid vitrectomy, suggesting that it can be used as a minimally invasive treatment for the N-SPDR patients in the future.2. Ranibizumab used for the N-SPDR patients as adjuvant therapy before vitrectomy, can reduce the intraoperative significant bleeding, easy to strip membranes, obviously reduce the damage to the retina, decrease the rate of silicone oil filling. |
