Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
BMC Ophthalmol. 2023 Oct 4;23(1):400. doi: 10.1186/s12886-023-03157-z.
To evaluate outcomes of panretinal photocoagulation (PRP) plus intravitreal conbercept (IVC) for diabetic retinopathy (DR) in real world and explore risk factors for patients with poor reactivity and presence of vision-threatening complications after combination treatment.
Retrospective review of DR patients received PRP plus IVC over 6 months. The main outcome was improvement ≥ 2 steps in ETDRS diabetic retinopathy severity scale (DRSS) levels. Different strategies for eyes receiving IVC within or over 1 month after PRP were analyzed. For patients with DRSS improvement < 2 steps and presence of vision-threatening adverse events, a binary logistic regression method was used to select risk factors.
Sixty one eyes were involved in this study. After treated with combination therapy with a median number of 3 injections, 44% of eyes improved ≥ 2 steps in DRSS levels. A total of 14 eyes (23%) occurred vision-threatening adverse events. No significant difference was found in eyes receiving conbercept within or over 1 month after PRP. Duration of diabetes (OR 0.849, 95%CI 0.734-0.982, P = 0.027), GFR (OR 0.961, 95%CI 0.933-0.990, P = 0.010) and baseline DRSS levels (OR 3.290, 95%CI 1.483-7.295, P = 0.003) were independent risk factors for DRSS improvement < 2 steps after treatment. Occurrence of vision-threatening complications was only related to high DRSS levels (OR 3.668, 95%CI 1.710-7.868, P = 0.001).
The combination therapy was effective for most patients with DR in real world. Eyes received PRP combined with earlier or later conbercept was demonstrated no significant difference for outcomes. For patients with poor renal function, high DRSS levels or occurred DR at the early stage of diabetes, follow-up should be strengthened.
评估现实世界中全视网膜光凝 (PRP) 联合康柏西普 (IVC) 治疗糖尿病视网膜病变 (DR) 的疗效，并探讨联合治疗后反应不良和出现威胁视力并发症的患者的风险因素。
回顾性分析了 6 个月内接受 PRP 联合 IVC 治疗的 DR 患者。主要结局是 ETDRS 糖尿病视网膜病变严重程度量表 (DRSS) 水平改善≥2 步。分析了 PRP 后 1 个月内或 1 个月后接受 IVC 的眼的不同策略。对于 DRSS 改善<2 步且存在威胁视力的不良事件的患者，采用二元逻辑回归方法选择风险因素。
本研究共涉及 61 只眼。经过联合治疗，中位数注射 3 次后，44%的眼在 DRSS 水平上改善≥2 步。共有 14 只眼（23%）发生威胁视力的不良事件。PRP 后 1 个月内或 1 个月后接受康柏西普的眼之间无显著差异。糖尿病病程（OR 0.849，95%CI 0.734-0.982，P=0.027）、肾小球滤过率（OR 0.961，95%CI 0.933-0.990，P=0.010）和基线 DRSS 水平（OR 3.290，95%CI 1.483-7.295，P=0.003）是治疗后 DRSS 改善<2 步的独立风险因素。威胁视力并发症的发生仅与高 DRSS 水平相关（OR 3.668，95%CI 1.710-7.868，P=0.001）。
该联合疗法对现实世界中大多数 DR 患者有效。PRP 联合早期或晚期康柏西普治疗的效果无显著差异。对于肾功能不佳、DRSS 水平较高或糖尿病早期发生 DR 的患者，应加强随访。
