玻璃体腔内注射曲安奈德治疗黄斑水肿的临床疗效观察

Intravitreal injection of triamcinolone acetonide for macular edema

目的:评价玻璃体腔内注射曲安奈德(TA)治疗黄斑水肿的疗效和安全性。方法:纳入45例50眼有黄斑持续水肿的病史,分为两组:TA组:23例25眼,接受玻璃体腔注射4mg(0.1mL)曲安奈德;对照组:22例25眼,接受黄斑格栅状光凝术,两组随访时间为6mo,分析两组治疗前及治疗后的最佳矫正视力、光学相干断层扫描检测黄斑中心凹视网膜厚度、10～2阈值检测程序行视野检查、及眼压的变化情况。结果:TA组在治疗后1、3mo平均最佳矫正视力、平均黄斑阈值敏感度、中心10°平均光敏感度比对照组值高,平均黄斑中心凹厚度比对照组值低(P<0.05),6moTA组的平均黄斑阈值敏感度高于对照组(P<0.05),其余三项指标均无显著性差异(P>0.05)。TA组治疗后14眼(56%)先后出现不同程度的高眼压,对照组患者治疗后发现有2眼(8%)(均为视网膜中央静脉阻塞)眼压升高现象,两组比较高眼压发生率有显著性差异(P=0.000),局部应用降眼压药物治疗可恢复至正常范围,其中部分高眼压患者需全身用药。结论:玻璃体腔内注射TA治疗黄斑水肿在0.5a内安全有效。

AIM：To evaluate the clinical effects and security of intravitreal injection of triamcinolone acetonide（TA） for macular edema. METHODS：A total of 50 eyes in 45 patients with persistent macular edema were enrolled and divided into two groups.Group TA included 25 eyes of 23 patients who received 4mg/0.1mL of intravitreal triamcinolone injection.The control group consisted of 25 eyes of 22 patients who received grid macular photocoagulation.Two groups were followed up for 6 months.Best corrected visual acuity,optical coherence tomography（OCT）,perimetry,and intraocular pressure（IOP） were examined before and after treatment for comparative analyses between two groups.OCT was performed to measure the neuroepithelial layer thickness of macular fovea.And perimetry was performed by HumphreyⅡ-750 visual field analysis.We used the central 10-2 fast threshold program to examine the change at central 10 degree. RESULTS：Mean improvement in best corrected visual acuity,macular threshold sensitivity and central 10°mean light sensitivity at post-injection 1-,3-month examination was significantly higher in Group TA when compared with the control group,and mean central macular thickness in Group TA was lower than that in the control group（P〈0.05）.At 6 months post-injection there is significant difference in macular threshold sensitivity between TA and control group（P〈0.05）,and the other results have no statistical significance（P〉0.05）.The intraocular pressure（IOP） elevated in 14 eyes（56%） in Group TA.In the control group,there were 2 eyes（8%） suffering from central retinal vein occlusion and undergoing IOP elevation.There is significant difference in incidence of IOP elevation between Group TA and control group（P=0.000）.But high IOP can be controlled to normal level by local drops.Some of the patients who got high IOP needed systemic therapy. CONCLUSION：Intravitreal injection of TA is safe and effective for macular edema in the first 6 months.