Clinical Observation Of Different Treatment Methods For High-risk Proliferative Diabetic Retinopathy Patients With Good Central Vision

Part I:Comparative study of the efficacy of intravitreal injection of conbercept combined with panretinal laser photocoagulation versus panretinal laser photocoagulation alone for high-risk proliferative diabetic retinopathy patients with good central visionObjective Retrospective case-control study.To observe and compare the clinical efficacy of intravitreal injection of conbercept?IVC?combined with panretinal laser photocoagulation?PRP?and PRP alone in the treatment of high-risk proliferative diabetic retinopathy?PDR?patients with good central vision.Method Patients diagnosed with high-risk PDR in the Department of Ophthalmology,Jiangsu Subei People's Hospital from November 2018 to August 2019 whose best-corrected visual acuity?BCVA?was not less than 0.6 were selected as participants in this study.According to treatments,they were divided into IVC combined PRP group and PRP alone group.Patients in combined treatment group received 0.5mg IVC first and PRP1 week later,PRP treatment should be accomplished in 1 month.In the combined treatment group,there were 47 eyes of 45 patients;in the monotherapy group,there were 60 eyes of 55 patients.Collecting baseline data of participants:gender,age,duration of diabetes,hypertension,mean arterial pressure?MAP?,glycated hemoglobin A_1c(Hb A_1c),creatinine value,central subfield thickness?CST?,VH condition,initial BCVA and retinal neovascularization degree.Following up 6 months and collecting BCVA at 1month and 6 months after treatment,comparing the eye numbers of new or increasing vitreous hemorrhage,macular edema,hemorrhage requiring pars plana vitrectomy?PPV?in two groups.Results 1.Gender,age,duration of diabetes,hypertension,MAP,Hb A_1c,creatinine value,CST,VH condition,initial BCVA and retinal neovascularization degree were not significantly differenct between the two groups?P>0.05?.2.At 1 month follow-up,there was no significant difference in combined treatment group between BCVA at 1 month?0.14±0.10?and initial BCVA?0.12±0.09??P=0.135?;nor in the monotherapy group between BCVA at 1month?0.19±0.34?and initial BCVA?0.11±0.09??P=0.076?;At 6 month follow-up,there was a significant difference in combined treatment group between BCVA at 6month?0.16±0.14?and initial BCVA?0.12±0.09??P=0.017?;so in the monotherapy group between BCVA at 1 month?0.30±0.50?and initial BCVA?0.11±0.09??P=0.005?.3.Comparing the two follow-ups BCVA between two groups,the average visual acuity of the combined treatment group was better than that of the monotherapy group,but the difference was not statistically significant?P=0.791,0.122?.4.At the end of follow-up,there were fewer cases of macular edema in the combined group?12.8%,16.4%?but without a significant difference?P=0.741?.5.At the end of follow-up,there were more cases of new or increasing vitreous hemorrhage in monotherapy group?30.0%,12.8%?with a significant difference?P=0.034?.Among the new or increasing vitreous hemorrhage cases from monotherapy group,there were5 cases?8.3%?occurred during the treatment but none in the combined treatment group?P=0.043?.And among the cases who accomplished corresponding treatments,the new or increasing vitreous hemorrhage cases was less in the combined treatment group?12.8%,21.7%?but without a significant difference?P=0.232?.6.There was no significant difference of PPV cases between the combined treatment group and monotherapy group?4.3%,15.0%,P=0.108?.Conclusion For high-risk PDR patients with good central vision,IVC combined with PRP has certain efficacy in the prevention of mass VH during the treatment and is conducive to obtaining the therapeutic time window for accomplishing PRP,so as to protecting visual acuity somehow.But there was no significant effect on preventing the recurrence of VH.Part?:multivariate analysis of visual acuity prognosis in patients with high risk proliferative diabetic retinopathy with good central visionObjective To explore the correlation between baseline characteristics and vision prognosis of high-risk PDR patients with good central vision.Method We recruited the same patients as part one research and dividing them into vision unimpaired group and vision impaired group according to the vision prognosis,respectively.In combined treatment group,there were 34 eyes of 32 patients in vision unimpaired group;13 eyes of 13 patients in vision impaired group.In monotherapy group,there were 35 eyes of 32 patients in vision unimpaired group;25 eyes of 23 patients in vision impaired group.Binary logistic regression was used to analyze the correlation between gender,age,duration of diabetes,hypertension,MAP,Hb A_1c,creatinine value,neovascularization degree,CST,VH condition and initial BCVA and vision prognosis.Results In combined treatment group,MAP?OR=1.055,P=0.027?had a statistically significant correlation with vision prognosis.In monotherapy group,the correlation between MAP?OR=1.069,P=0.016?,initial VH?OR=10.150,P=0.017?and degree of neovascularization?OR=1.104,P=0.045?and visual acuity prognosis were statistically significant.Other baseline characteristics did not show statistically significant correlation.Conclusion MAP has a certain effect on the vision prognosis of high-risk PDR patients with good central vision in both groups,and VH condition and degree of neovascularization were also significant for patients in monotherapy.