玻璃体腔注射曲安奈德治疗黄斑水肿的眼压变化(英文)

Changes of intraocular pressure after intravitreal injection of 4mg triamcinolone acetonide in treatment of macular edema

目的:研究玻璃体腔注射4mg曲安奈德(IVTA)治疗黄斑水肿后的眼压(IOP)变化及其相关因素。方法:本研究为回顾性、连续性及非对照病例序列研究。包括93眼黄斑水肿患者,病因分别为视网膜静脉阻塞(54眼)和糖尿病视网膜病变(39眼),都接受了4mgIVTA注射。所有病例均在注射前和注射后14d,1,2,3,4,5,6mo随访眼压变化。并分析基础IOP,病因,年龄和性别与眼压的相关性。结果:注射后14dIOP显著升高(16.02±2.45mmHg,P<0.001),注射后2mo达到高峰(18.80±6.20mmHg,P<0.001)。注射后14d有2眼眼压超高21mmHg(2.2%),术后1,2,3,4,5,6mo分别是14(15.1%),18(19.5%),9(9.6%),4(4.3%),0,0。注射后14d有1眼(0.01%)眼压较基础眼压升高超过5mmHg,术后2mo达到高峰,为22眼(23.7%)。注射后1mo有5眼(5.3%)眼压升高10mmHg,2mo最高为12眼(12.9%)。IOP升高和年龄(相关系数-0.18～-0.29,P<0.05),基础眼压(相关系数0.52～0.79,P<0.001)及糖尿病(相关系数0.23,P<0.001)显著相关,但与性别无相关性(相关系数-0.002～0.04,P>0.05)。所有患眼的IOP均能通过局部降眼压药物控制到正常,没有1例发生青光眼性视神经病变。结论:4mgIVTA注射后眼压升高是很普遍的现象,注射后应该至少随访观察6mo以上。所有患眼的高眼压均能通过局部降眼压药物得到控制。对于基础眼压较高,糖尿病视网膜病变及年轻患者更应该关注注射后的眼压变化。

AIM：To investigate the changes of intraocular pressure（IOP） and associated factors of IOP elevation after 4mg intravitreal injection of triamcinolone acetonide（IVTA） in treatment of macular edema.METHODS：The study is prospective,consecutive,and non-comparative interventional case series including 93 eyes with macular edema associated with retinal vein occlusion（n=54 eyes） or diabetic retinopathy（n=39 eyes） ,which received 4mg IVTA injection.The change in IOP was followed for all cases at pre-operation and 14 days,1,2,3,4,5,and 6 months post-operation.Associated factors of IOP elevation were examined regarding baseline IOP,causal disease,age and gender.RESULTS：IOP increased significantly（P〈0.001） at 14 days 16.02±2.45mmHg after injection and peaked at 18.80±6.20 at 2 months post-injection（P〈0.001） from 14.85±2.55 mmHg preoperatively.An IOP rise to the value higher than 21mmHg was observed in 2（2.2%） eyes 14 days after injection and which was observed in 14（15.1%） ,18（19.5%） ,9（9.6%） ,4（4.3%） ,0,and 0 eyes respectively at 1,2,3,4,5,and 6 months after injection.One eye（0.01%） showed pressure elevation of over 5mmHg than baseline 14 days after injection and IOP peaked to 22mmHg（23.7%） at 2 months after injection.Five（5.3%） eyes had an increase of 10mmHg at 1 month and IOP peaked to 12mmHg（12.9%） at 2 months after injection.The rise in IOP was statistically associated with younger age（correlation coefficient-0.18——0.29,P 〈0.05） ,high baseline IOP（correlation coefficient 0.52-0.79,all P 〈0.001） ,and the presence of diabetes mellitus（correlation coefficient 0.23,P〈0.001） but independent of gender（correlation coefficient-0.002-0.04,all P 〉0.05） .In all eyes,IOP could be lowered to the normal range with topical medication,without development of glaucomatous optic nerve head changes.CONCLUSION：Elevated IOP after 4mg IVTA injection is common and patients should be monitored beyond 6 months post-injection.In all the cases,IOP can be normalized by topical medication.Patients with high baseline IOP,diabetic retinopathy,and younger age should be carefully monitored for an elevated IOP.