OCT对玻璃体腔内注射曲安耐德治疗弥漫型糖尿病黄斑水肿的疗效评价

Evaluation of the therapeutic effect of intravitreal injection of triamcinolone for diffuse diabetic macular edema by OCT

目的 探讨光学相干断层扫描 (OCT)在玻璃体腔内注射曲安耐德 (TA)治疗弥漫型糖尿病黄斑水肿 (DME)疗效评价中的作用。方法 对激光治疗无效的弥漫型DME 2 4例患者的 (2 5只眼 )进行玻璃体腔内注射TA 0 1ml(4mg)治疗 ,治疗前后检查项目包括视力、眼底血管荧光造影 (FFA)和OCT对黄斑区视网膜厚度的测量。随访期 3～ 6个月 ,平均 4 5个月。结果 最佳矫正视力治疗前为0 12± 0 0 7,治疗后为 0 3± 0 16 (P<0 0 1) ,2 2只眼的视力得到提高。黄斑中心凹视网膜神经上皮层厚度治疗前为 4 71 76± 191 30 μm ,治疗后为 193 88± 5 3 2 2 μm ,治疗前后比较差异有统计学意义 (P <0 0 1) ;距黄斑中心凹 10 0 0 μm鼻侧、颞侧、上方、下方视网膜神经上皮层平均厚度治疗前为 4 6 2 72±12 3 76 μm ,治疗后为 2 78 36± 5 7 6 1μm(P <0 0 1)。结论 对激光治疗无效的弥漫型DME ,玻璃体腔内注射TA治疗后黄斑部视网膜水肿消退明显 ,患者视力得到提高 ;OCT能从黄斑部视网膜形态的改变上客观、精确、有效地评判这一方法的疗效。

Objective To evaluate the effect of intravitreal injection of triamcinolone for diffuse diabetic macular edema with optical coherence tomography (OCT). Methods 24 patients (25 eyes) with diffuse diabetic macular edema that failed to respond to previous treatment with of laser photocoagulation received an intravitreal injection of 4mg/0.1ml triamcinolone to each eye. The visual acuity, founds fluorescein angiography (FFA), and measurement of the macular retinal thickness with OCT were examined before and after the therapy. Mean follow-up time was 4.6 months (range 3-6 months ). Results Mean best-corrected visual acuity was improved from 0.12±0.07 to 0.30±0.16, the visual acuity improvement was statistically significant(P<0.01). Visual acuity of 22 eyes (88%) was improved. The thickness of fovea neuroepithelium was decreased signifcantly from 471.76±191.30μm to 193.88±53.22μm (P<0.01), and that of some other parts of the retina (mean thickness of nasal, temporal, superior and inferior neuroepithelium, which were 1000μm distant from macular fovea) was decreased from 462.72±123.76μm to 278.36±57.61μm (P<0.01). Conclusions Intravitreal injection of triamcinolone may be beneficial in improving visual acuity and reducing macular edema for the patients with diffuse diabetic macular edema that failed to respond to previous treatment with laser photocoagulation. OCT can evaluate the therapeutic effects objectively, accurately and effectively by demonstrating the morphological changes in macular retina.