曲安奈德治疗非缺血型视网膜中央静脉阻塞黄斑水肿疗效评价

lntravitreal Injection of triamcinolone acetonide for the treatment of cystoid macular edema associated with nonischemic central retinal vein occlusion

目的评价玻璃体内注射4mg、6mg曲安奈德（TA）以及玻璃体切除术联合玻璃体内注射4mgTA3种方法的治疗非缺血型视网膜中央静脉阻塞（CRVO）效果。方法采用随机、平行对照方法，将非缺血型CRVO合并黄斑囊样水肿（CME）患者分为3组，比较3组患者视力改善黄斑水肿消退及并发症发生情况。结果3组患者治疗后视力及黄斑水肿均明显改善，治疗前后差异有统计学意义（P＜0.05），但组间无统计学意义（P＞0.05）。随访期间，3组患者中CME均有复发，3组复发率无统计学意义（P＞0．05）。治疗后主要并发症为高眼压，3组高眼压的发生率分别为53．3％．50．0％、9．1％，玻璃体切除组高眼压的发生率与单纯注药组比较差异有统计学意义（P＜0．05）。结论玻璃体内注射TA对于非缺血型CRVO合并CME患者治疗有效，小剂量增加TA及联合玻璃体切除在疗效方面无明显差异，但联合玻璃体切除术可以降低高眼压的发生。

Objective To investigate the efficacy and safety of IVTA 4mg, 6mg and vitrectomy associated with IVTA 4mg and to compare the difference of curative effects among the three study groups. Methods Using randomized, paralleled group control study to choose patients with CME associated with CRVO. The curative effects and side effects were compared among the three study groups. Results The all groups were significantly different in BCVA and CMT before and after treatment （P〈0.05）. The between-group differences were not statistically significant at each time point （P〉0.05）. The most familiar adverse event after treatment was high IOP. The incidence rate of high lOP is 53.3% in 4mg study group and 50.0% in 6mg study group. In vitrectomy＋4mg group the incidence rate of high IOP is 9.1%. The incidence rate of high IOP in vitrectomy＋4mg group was statistically different compared with 4rag and 6mg study groups （P〈0.05） .Conclusions Intravitreal injection with TA is effective for CME associated with noischemic CRVO in a short term. Associating with vitrectomy and increasing little dose of TA is not very much effective for CME associated with noischemic CRVO. But vitrectomy associated with intravitreal injection with TA can reduce the occurrence of high IOP.