去炎松玻璃体内注射治疗视网膜中央静脉阻塞引起的黄斑水肿37例

Intravitreal triamcinolone acetonide injection for macular edema due to central retinal vein occlusion

目的:评估去炎松玻璃体内注射治疗视网膜中央静脉阻塞造成的黄斑水肿效果。方法:中央视网膜静脉阻塞(CRVO)并发黄斑水肿患者37例(37眼)接受玻璃体腔注射去炎松(40g/L,0.1mL,1～3次)治疗。非缺血性CRVO33眼,缺血性CRVO4眼,注射1次20眼,注射2次15眼,注射3次2眼,平均随访时间9(3～27)mo。患者从症状出现至一次注射药物平均时隔时间为2.7(0.3～9)mo。注射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)和中央黄斑厚度光相干断层扫描(OCT)检查。结果:治疗前平均视力为0.08(0.01～0.4)。注射后1～3mo,最佳矫正视力提高25眼,无变化3眼,视力下降9眼,在视力提高患眼中,视力提高3行以上12眼,视力提高2行10眼,提高1行3眼。此后,部分视力下降和视力未提高患者,进行2次或3次注射,最终随诊时视力提高24眼,视力无变化3眼,视力下降10眼,在视力提高的患眼中,视力提高3行以上8眼,视力提高2行10眼,提高1行6眼,整个治疗前后平均视力增加2～3行。治疗后1～3mo时,间接眼底镜检查黄斑水肿完全消退16眼,水肿明显减轻19眼,水肿加重2眼。最终随诊时,间接眼底镜检查黄斑水肿完全消退19眼,减轻17眼,加重1眼。15眼在注射药物后1wk～6mo期间先后出现不同程度的高眼压达35.4(25.1～40.1)mmHg(1mmHg=0.133kPa),13眼进行降眼压治疗,其中4眼接受抗青光眼手术。在32只晶状体眼中,出现了晶状体后囊膜下混浊的并发性白内障9眼,进行白内障摘除4眼。OCT检查发现玻璃体腔注射药物治疗后黄斑厚度减少,中央黄斑平均厚度减少至注射前厚度的46%。4眼没有视力的提高。结论:玻璃体腔内注射去炎松是一种治疗视网膜中央静脉阻塞引起黄斑水肿的有效方法。对于缺血性中央视网膜静脉阻塞患者视力不会提高。

AIM： To investigate the efficacy of intravitreous injection with triamcinolone acetonide （TA） for macular edema （ME） due to central retinal vein occlusion （CRVO）. METHODS： Medical records of 37 eyes of 37 patients were retrospectively reviewed that were injected with 4 mg of intravitreal TA for treatment of ME due to CRVO. Of the 37 eyes, including 33 non-ischemic and 4 ischemic CRVO, 20 were injected once, 15 twice and 2 three injections. Mean follow-up time was 9 months （range, 3-27 months）. The average time between onset of symptoms and first injection was 2.7 months （range, 0.3-9 months）. Available documents on preand post-injection best corrected visual acuity, intraocular pressure, slit lamp microscope check, fundus fluorescein angiography （FFA） and optical coherence tomography （OCT） central foveal thickness were evaluated. RESULTS： The average visual acuity （VA） was 0.08 （range, 0.01-0.4） before the treatment; while between 1 and 3 months after the injection, the best corrected VA improved in 25 patients, did not change in 3 eyes and worsened in 9 eyes. Of the 25 improved eyes, 12 eyes gained more than 3 lines of VA, 10 eyes improved by 2 lines and 3 eyes by 1 line. After then, some worsened and unimproved eyes received the second or the third injection. At the last follow-up, he best corrected VA improved in 24 eyes, did not change in 3 eyes and worsened in 10 eyes. Of the improved eyes, 3 eyes gained more than 3 lines of visual acuity, 10 eyes improved by 2 lines, 6 eyes by 1 line and the whole average VA improved by 23 lines. During 1-3 months after the treatment, observed by indirect funduscopy, the ME disappeared in 16 eyes, alleviated in 19 eyes and worsened in 2 eyes. In the final visit, ME disappeared in 19 eyes, alleviated in 17eyes and aggravated in 1 eye. Fifteen patients without a history of glaucoma developed ocular hypertension of 35.4 mmHg （25.1-40.1 mmHg, 1 mmHg=0.133 kPa） at 1 week up to 6 months after injection, and 13 eyes required glaucoma medication. Trabeculectomy was performed on 4 eyes with glaucoma. Nine of 32 phakic eyes showed progression of posterior capsule cataract, 4 of which underwent cataract extraction. All injections resulted in reduction in central foveal thickness as determined by OCT. The mean central foveal thickness decreased to 46% of preinjection values （n = 23, 687μm vs. 322 μm, respectively; P 〈 0.001）. The VA of the 4 ischemic CRVO patients did not improve. CONCLUSION： Intravitreal TA may be effective in treating ME caused by CRVO. Subjects with ischemic central retinal vein were less likely to have visual improvement.