玻璃体内注射曲安奈德治疗视网膜中央静脉阻塞引起的黄斑囊样水肿

Intravitreous injection with triamcinolone acetonide for cystoid macular edema due to central retinal vein occlusion

目的观察玻璃体内注射曲安奈德(TA)治疗视网膜中央静脉阻塞(CRVO)引起黄斑囊样水肿(CME)的疗效和安全性。方法14例CRVO所致CME患者14只眼玻璃体内注入40mg/ml的TA0.1ml。治疗前后均进行最佳矫正视力、眼压、裂隙灯显微镜、荧光素眼底血管造影(FFA)和光相干断层扫描(OCT)检查。随诊观察10.0～22.4个月,平均随诊观察时间为15.9个月。结果治疗前平均视力为0.1。治疗1、3个月时,100%的患眼视力提高,其中,视力≥0.2者分别为71.4%和63.6%,视力≥0.5者分别为42.9%和27.3%。此后,部分患者视力下降,最终随诊时视力≥0.2者占28.6%,≥0.5者占7.1%,与治疗前比较,71.4%的患眼视力有不同程度的提高,28.6%的患眼视力下降。治疗后1个月时,OCT检查显示黄斑水肿完全消退10只眼,占71.43%,水肿明显减轻4只眼,占28.57%。最终随诊时,OCT检查显示黄斑水肿完全消退4只眼,减轻9只眼,加重1只眼。7只眼在注射药物后1周～6个月期间先后出现不同程度的高眼压,眼压达到22.3～40.1mmHg(1mmHg=0.133kPa),在最终随诊时7只眼出现了晶状体后囊膜下混浊的并发性白内障。结论玻璃体内注射TA短期内能有效改善黄斑水肿和明显提高视力,部分治疗眼出现高眼压;远期观察黄斑水肿的复发率和晶状体后囊膜下混浊的发生率均较高。

Objective To investigate the efficacy and safety of intravitreous injection with triamcinolone acetonide (TA) for cystoid macular edema (CME) due to central retinal vein occlusion (CRVO). Methods Fourteen eyes of 14 patients with CME due to CRVO underwent intravitreous injection with 0.1 ml TA (40 mg/ml). Best-corrected visual acuity, intraocular pressure (IOP), slitlamp examination, fundus fluorescein angiography, and optical coherence tomography (OCT) were performed on the patients before and after the injection. The follow-up period was 10-22.4 months, with the mean of 15.9 months. Results The average visual acuity was 0.1 before the treatment; while 1 month and 3 months after the injection, the visual acuity of all of the patients improved, including ≥0.2 in 71.43% and 63.6% of the patients, respectively, and ≥0.5 in 42.9% and 27.3%, respectively. After then, the visual acuity of some patients decreased, and in the final visit, 4 eyes (28.6%) had a visual acuity of ≥0.2, and 1 eye (7.1%) of ≥0.5. Compared with that before the treatment, the visual acuity of 10 (71.4%) eyes improved and 4 (28.6%) eyes declined. One month after the treatment, the macular edema disappeared in 10 eyes (71.4%) and alleviated in 4 (28.6%). In the final visit, macular edema disappeared in 4 eyes, alleviated in 9, and aggravated in 1. In the follow-up duration, high IOP [22.3-40.1 mm Hg (1 mm Hg=0.133 kPa)]. In the final visit, posterior subcapsular cataract was found in 7 eyes. Conclusion Intravitreous injection with TA may be effective in reducing CME and enhancing the visual acuity in a short term with high IOP in some eyes. In the long-term follow-up period, the rate of recurrence of CME and incidence of posterior subcapsular cataract is high.