玻璃体内注射曲安奈德联合玻璃体切割术治疗玻璃体积血

Clinical assessment of combination procedure of intravitreal triamcinolone injection and vitrectomy in patients with vitreous hemorrhage

目的探讨玻璃体内注射曲安奈德(TA)联合玻璃体切割术治疗玻璃体积血的临床应用。方法对因玻璃体积血住院手术的患者192例进行回顾性分析,比较玻璃体内注射TA联合玻璃体切割术和单纯行玻璃体切割术治疗前和治疗后ld、10d、1个月、3个月时患者的最佳矫正视力、眼压、眼内炎症反应和眼底改变。结果TA注射组在1个月、3个月最佳矫正视力高于单纯手术组,术后眼内炎症反应较单纯手术组降低,差异有统计学意义。结论与单纯玻璃体切割术比较,玻璃体内注射TA联合玻璃体切割术治疗玻璃体积血能在短期内获得更高的最佳矫正视力,并减少眼内炎症反应。

Objective Many researches showed that triamcinolone acetonide（TA） can treat many ocular fundus diseases effectively,and thus is widely concerned. This investigation was to assess the efficiency and safety of intravitreal triamcinolone injection during vitrectomy in patients with vitreous hemorrhage. Methods 192 cases of vitreous hemorrhage received vitrectomy were retrospectively investigated in this study. Patients undergone vitrectomy combined with intravitreal triamcinolone injection was as group A, and the patients with simple vitrectomy was as group B. Best corrected visual acuity, intraocular pressure （IOP）, inflammatory reaction,findings of lens and fundus were evaluated before surgery and 1 day, 10 days, 1 month,3 months after surgery and compared between group A and group B. Results There was no statistical difference in mean visual acuity in preoperation between two groups（t = 0. 165, P = 0. 820）. The mean acuity in 1 month and 3 months after surgery in group A was significantly higher than that of group B（t = 15. 334,P 〈0. 001 ;t = 18. 518 ,P 〈0. 001 ）. The grading and eye numbers of inflammatory reaction in group A was significantly decreased in comparison with group B （P 〈 0. 005 ）. The complication of intravitreal triamcinolone injection ＋ vitrectomy was elevation of intraocular pressure（ over 21 mmHg） in 13（ 13.5% ） of 96 eyes in group A and 11 （ 10. 2% ） of 108 eyes in group B（χ^2 = 0. 60,P = 0. 46）. Conclusion Combination of intravitreal triamcinolone injection and vitrectomy is helpful for recovery of visual function in short-term and present slight inflammatory process.