后Tenon囊下注射曲安奈德治疗弥漫性糖尿病黄斑水肿的临床观察

Clinical observation of posterior subtenon triamcinolone acetonide for diffuse diabetic macular edema

目的观察后Tenon囊下注射TA治疗格栅样光凝失败的弥漫性DME的有效性和安全性。方法选择因患弥漫性DME并已行格栅样光凝无效的患者（时间至少3个月以上）39例（42只眼）。随机分二组，一组给予后Tenon囊下注射TA（posterior subtenon TA，PSTT）20rag／0．5ml；另外一组给予玻璃体腔内注射TA（intravitreal TA，IVTA）4mg／0．1ml，分别于治疗前、治疗后1、2和3月进行最佳矫正视力、OCT、．眼压等检查，同时观察治疗后并发症，对结果进行统计分析，评价两种给药方式的临床疗效及安全性。结果PSTY组和IVTA组治疗后1、2和3月的最佳矫正视力（best—corrected visual acuity，BCVA）均提高，与治疗前视力相比差异具有统计学意义（P〈0．01）。两种注射方法之间在治疗前和治疗后各不同时间点，BCVA变化无统计学差异（P〉0．05）。PSTT组和IVTA组治疗后1月、2月和3月黄斑中心凹厚度与治疗前相比明显减低，差异具有统计学意义（P〈0．01）。两种注射方法之间在治疗前和治疗后各不同时间点，黄斑中心凹厚度差别无统计学差异（P〉0．05）。PSTT组治疗后眼压升高3例，占13．6％；IVTA组治疗后眼压升高6例，占30％，假性眼内炎1例。结论后Tenon囊下注射TA和玻璃体腔内注射TA对于格栅样光凝失败的弥漫性DME患者，都能在短期内不同程度地提高患者中心视力，有效降低黄斑区视网膜水肿。虽然玻璃体腔注射给药方式效果更为明显，但后Tenon囊下注射仍不失为一种安全、有效的给药途径。

Objective To evaluate the effectiveness and safety of posterior subtenon injection （PSTT） in DME refratory to conventional grid laser photocoagulation. Methods Thirty-nine cases （42 eyes） with clinical significant DME refratory to grid laser phtotcoagulation were assessed for the inclusion in the study and randomly divided into 2 groups. The PSTT group received 20mg/0.5ml TA and the IVTA group received 4mg/0.1 ml TA injection. Complete ophthalmic examination with best-corrected visual acuity （BCVA）, optic coherence tomography （OCT） and intraocular pressure （lOP） were performed before and in the 1st, 2nd, and 3rd months of the treatment. Results The BCVA during the treatment in both PSTT group and IVE group was significant increased compared to that ofpretreatment （P〈0.01）. The mean central foveal thickness during the treatment in both PSTT group and IVE group was significant decreased compared to that ofpretreatmerit （P〈0.01）. There was no significant difference with respect to the decrease in the central foveal thickness and increase in the visual acuity between the PSTT group and the/VTA group. Significant lOP increase was found in 13.6% of the PSTT group and in 30% of the IVTA group. There was one case of pseudomonas endophthalmitis in the IVTA group. Conclusions Both PSTT and IVTA injections caused a significant increase in visual acuity and a decrease in central foveal thickness, especially in the short term. Although the effect was more pronounced in the IVTA group, the PSTT injection also seemed to be a safe and effective technique for the treatment of DME.