玻璃体腔曲安奈德注射联合黄斑格栅样光凝治疗糖尿病性弥漫性黄斑水肿

Intravitreal triamcinolone acetonide combined with macular laser grid photocoagulation for diffuse diabetic macular edema

目的观察玻璃体腔曲安奈德注射（intravitreal triamcinolone acetonide,IVTA）联合黄斑格栅样光凝（macular laser grid photocoagulation,MLG）治疗糖尿病性弥漫性黄斑水肿（diffuse diabetic macular edema,DME）的疗效。方法对24例（26眼）DME患者行IVTA治疗,1m后联合MLG治疗。观察联合治疗前和联合治疗后（1、3、6、9、12）m时患者的视力、眼压、眼内炎性反应、晶体及眼底改变,同时应用光相干断层成像术（optic coherent tomography,OCT）测量黄斑区视网膜厚度。随访6m～18m（平均12m）。结果所有26眼中,有23眼（88.5%）视力提高,3眼（11.5%）视力不变。黄斑中心凹平均厚度联合治疗前为（556±189）μm,联合治疗后（1、3、6、9、12）m时分别为：（285±151）μm;（205±87）μm;（209±107）μm;（216±76）μm;（220±93）μm。联合治疗前后比较差异有统计学意义（P〈0.001）。在本研究随访期间,所有患者未发生黄斑水肿复发。26眼中4眼（15.4%）术后暂时性眼压轻度升高,1眼（3.8%）白内障加重。结论IVTA联合MLG可以有效地治疗DME,提高视力并减少黄斑水肿的复发。

Objective To evaluate the efficacy of intravitreal triamcinolone acetonide （IVTA） combined with macular laser grid photocoagulation （MLG） in the treatment of diffuse diabetic macular edema （DME）.Methods 26 eyes of 24 patients with DME underwent IVTA, combined with MLG one month later. Best-corrected visual acuity, intraocular pressure （lOP）, inflammatory extent, manifestation of lens and fundus were observed before treatment and 1,3,6,9,12 months after treatment. The retinal thickness was examined by optic coherent tomography （OCT）. Mean follow up was 12 months （range 6 to 18 months） Results Of all 26 eyes 23 eyes（88.5%） had improved visual acuity 3 eyes（11.5%） remained the same. The average retinal thickness at macular area was 556 ± 1891.tin, before treatment, while 1,3,6,9,12 months after combined treatment, the average retinal thickness was 285 ±151μm 205 ±871μm 209 ± 107μm; 216 ± 76μm; 220 ＋ 93μm respectively, which had statistical significance compared with that before treatment.（P〈0.001） Transient intraocular pressure elevation occurred in 4 patient（15.4%）of all 26 eyes, and cataract progressed in 1 patient（3. 8%）. Conclusions IVTA combined with MLG improve the visual acuity and reduce the central macular thickness of DME, and decrease the recurrence of macular edema.