曲安奈德预防术后增殖性玻璃体视网膜病变临床观察

Effects of intravitreal administration of triamcinolone acetonide on postoperative proliferative vitreoretinopathy

目的:评价曲安奈德(triamcinolone acetonidem,TA)在预防玻璃体切除术后增殖性玻璃体视网膜病变(proliferative Vitreoretinopathy,PVR)发生过程中的安全性和有效性.方法:2004-03/2004-10行玻璃体手术治疗视网膜脱离患者75例78眼,分为治疗组与对照组各39眼.治疗组术中玻璃体腔内注入TA 0.5～1mL(4mg),对视网膜表面残存的玻璃体进行标识,将黏附曲安奈德的玻璃体皮质完全剥除.手术结束玻璃体腔内再注入TA 0.1mL 4mg).对照组未用TA.平均随访6.8mo,两组结果进行对比分析.结果:治疗组与对照组术后PVR发生率分别是8%和28%,有显著性差异(P＜0.05).治疗组术后视网膜脱离复发率5%,对照组为20%,有显著性差异(P＜0.05).术后2mo眼压≥21mmHg分别是31%和13%,有显著性差异(P＜0.05).两组手术前后视力的变化无差异.未见明显与药物有关的眼部并发症.结论:曲安奈德可以帮助显示透明的玻璃体皮质,容易辨认和剥除,提高手术安全性及成功率.有抗炎和抗增殖的作用,可以预防PVR的发生.

AIM： To evaluate the security and efficacy of triamcinolone acetonide （TA） on prevention of proliferative vitreoretinopathy （PVR） after vitrectomy surgery. METHOD： From March to October 2004, 75 cases （78 eyes） with retinal detachment （RD） were randomly chosen and were divided into Study Group and Control Group. Being injected 0.5-1.0mL （4rag） intravitreally into the eyes of Study Group during the surgery, TA can demarcate the residue vitreous body sticking to the retinal surface and help to peel it off completely. At the end of the operation, 0.1mL （4rag） TA was injected into vitreous cavity again. In the eyes of Control Group, no TA was injected intravitreally. The mean follow-up was 6.8 mo. The results of the two groups were compared and analyzed. ~ RESULTS： In Study Group and Control Group, the incidence rate of PVR was 8% and 28% respectively, and the recurrence rate of RD was 5% and 20% respectively. The comparison showed statistical discrepancy （P〈0.05）. The incidence rate of intraocular pressure higher than and equal to 21mmHg at 2mo after surgery was 31% and 13% respectively, and the difference showed statistical significance （,0〈0.05）. There was neither difference in visual acuity before and after surgery nor obvious ocular complication related to TA. CONCLUSION： TA can help to demarcate the transparent vitreous cortex and make it discernible and easy to be peeled off completely, which can improve the safety and success rate of surgery. TA has the functions of anti-inflammation, proliferation, and prevention of the occurrence of PVR.