滤过器联合三通管除去曲安奈德混悬液中赋形剂的临床应用

Filter combine with three way cock to remove the vehicles in triamcinolone acetonide for clinical use

目的评价用5μm滤过器联合三通管除去曲安奈德(triamcinoloneacetonide,TA)混悬液中赋形剂的临床应用效果。方法通过5μm滤过器联合三通管将TA混悬液置换成眼内灌注液,并分别对102例糖尿病视网膜病变、视网膜分支静脉阻塞和老年黄斑变性导致黄斑囊样水肿行玻璃体腔注射;41例糖尿病视网膜病变、黄斑前膜、增殖性玻璃体视网膜病变和黄斑裂孔患者行经睫状体平坦部玻璃体切割术(parsplanavitrectomy,PPV)辅助应用。观察PPV辅助应用时,玻璃体后皮质、视网膜前膜和内界膜与TA结合情况。随访1m-6m,观察矫正视力、眼内压、OCT及眼底荧光血管造影等变化。结果5μm滤过器联合三通管可除去曲安奈德混悬液赋形剂,而保留药物有效颗粒。在PPV辅助应用时,TA能与玻璃体皮质和视网膜内界膜结合,显示残留玻璃体后皮质和前膜,能发现内界膜。PPV辅助应用41例中,视力稳定和提高30例,4例发生眼内压升高,白内障进展2例。玻璃体腔内注射102例中,77例视力稳定和提高两行,28例发生眼内压升高,7例发生晶体后囊混浊。所有患者无一例发生眼内炎。结论滤过器联合三通管能有效除去曲安奈德混悬液中的赋形剂,可应用于玻璃体腔内注射治疗和玻璃体切割术中辅助应用。该方法安全简单,值得临床推广。

Objective To evaluate the effect of 5μm pore filter combine with three way cock on removing the vehicles in triamcinolone acetonide（TA） suspension for clinical use. Methods Through 5μm pore filter combine with three way cock, the TA suspension has been replaced by intraocular irrigating solution. The new suspension was apply to 102 cases of diabetic retinopathy, branch retinal vein occlusion, diabetic macular edema and age-related macular degeneration with the method of intravitreal injection; it also assisted pas plana vitrectomy（PPV） to treat with 41 cases of diabetic retinopathy, epimacular membranes, proliferative vitreoretinopathy and idiopathic macular hole. To observe if TA particles can adhere to posterior hyaloid, epiretinal membrane and internal limiting membrane during PPV. Follow-up was 1-6 months, and corrected visual acuity, intraocular pressure. OCT and fundus fluorescein angiography were recorded. Results 5μm pore filter combine with three way cock can successfully remove the vehicles in TA suspension while retain the TA particles. When it was applied to PPV, TA can adhered to posterior hyaloid, epiretinal membrane, internal limiting membrane and clearly visualized them. In all the 41 cases who have PPV therapy, 30 cases have stable or increased visual acuity, intraocular pressure increased in 4 cases, 2 case occured cataract. In the 102 cases who accepted intravitreal injections, 77 cases increased visual acuity at least 2 lines, intraocular pressure increased in 28 cases, 7 patients occurred posterior cystoid membrane obscured. None of the patients caught endophthalmitis. Conclusion Filter combine with three way cock can effectively remove the vehicles in TA suspension, and this procedure can be applied to intravitreal injection or PPV. This method is simply and safely, it deserve to popularize in clinic.