眼球后注射曲安奈德联合眼底激光治疗视网膜分支静脉阻塞继发黄斑囊样水肿的疗效观察

Effect of laser photocoagulation in combination with drug therapy on cystoid macular edema secondary to branch retinal vein occlusion

目的观察眼球后注射曲安奈德联合眼底激光治疗视网膜分支静脉阻塞(BRVO)继发黄斑囊样水肿(CME)的临床疗效。方法回顾性分析2012年1月至2013年8月山西省临汾市尧都区眼科医院眼底疾病科收治的42例(42只眼)BRVO继发CME患者的临床资料。按照随机数字表法将患者分为两组,即药物联合眼底激光治疗组(21只眼)和单纯眼底激光治疗(21只眼)。治疗后3个月,两组患者的CME情况及视力变化情况比较分别采用卡方检验和Kruskal-Wallis H秩和检验。结果治疗后3个月,药物联合眼底激光组黄斑囊样水肿减轻者18只眼(85.7%),黄斑囊样水肿未减轻者3只眼(14.3%);单纯眼底激光治疗组黄斑囊样水肿减轻者7只眼(33.3%),黄斑囊样水肿未减轻者14只眼(66.7%),两组患者CME情况比较,差异有统计学意义(χ2=11.96,P<0.05)。药物联合眼底激治疗光组视力提高者13只眼(61.9%),视力不变者5只眼(23.8%),视力下降者3只眼(14.3%);单纯眼底激光治疗组视力提高者5只眼(23.8%),视力不变者12只眼(57.1%),视力下降者4只眼(19.1%),两组患者视力变化情况比较,差异有统计学意义(Hc=6.58,P<0.05)。所有患者均未出现眼内炎症、白内障及视网膜脱离等并发症。结论眼球后注射曲安奈德联合眼底激光治疗BRVO继发的CME安全、有效,其效果优于单纯眼底激光疗法。

Objective To assess the therapeutic effect of laser photocoagulation in combination with Trans-Tenon′s retrobulbar injection of triamcinolone acetonide on cystoid macular edema( CME) secondary to branch retinal vein occlusion(BRVO).Methods The clinical data of 42 patients (42 eyes) with CME secondary to BRVO treated in Eye Hospital of Shanxi Province in Linfen between January 2012 and August 2013 were retrievedand stratified into two treatment groups: laser photocoagulation and drug therapy in combination (n=21) and laser photocoagulation alone (n=21).The degree of CME and visual acuity after 3-month follow-up in the two groups were analyzed by chi-square test and Kruskal-Wallis H rank sum test. Results Edema reduction was observed in 18 (85.7%) eyes after drug therapy in combination with laser photocoagulation,but only in 7(33.3%) after treatment with laser photocoagulation alone (χ2=11.96,P <0.05).Visual acuity was improved in 13 (61.9%) eyes,remained unchanged in 5(23.8%) eyes and decreased in 3 (14.3%) eyes in the combination treatment group while it was improved in 5 (23.8%) eyes, remained unchanged 12 ( 57.1%) eyes and decreased in 4 ( 19.1%) eyes in the laser photocoagulation group.The difference between the two groups was statistically significant (Hc=6.58,P<0.05).Neither entophthalmia nor cataract,retinal detachment and other complications were observed in both groups.Conclusion Laser photocoagulation in combination with Trans-Tenon′s retrobulbar injection of triamcinolone acetonide offers a safe treatment for cystoid macular edema secondary to branch retinal vein occlusion,which is more effective than laser therapy alone.