曲安奈德球内注射与经Tenon囊球后注射治疗视网膜静脉阻塞黄斑水肿的对比性研究

Relative property study of triamcinolone acetonide intravitreal and trans-tenon's retrobulbar injection treat retinal vein obstruction patients with macular edema

目的:对比曲安奈德(triamcinolone acetonide,TA)玻璃体内注射和经Tenon囊球后注射治疗视网膜静脉阻塞黄斑水肿的有效性及安全性。方法:视网膜静脉阻塞黄斑水肿患者114例(114眼),男72眼,女42眼。曲安奈德球内注射治疗66例(66眼),男43眼,女23眼;曲安奈德Tenon囊球后注射治疗48例(48眼),男29眼,女19眼,对两组患者通过观察视力、眼压、光相干断层成像术(optic coherence tomagraphy,OCT)检查,比较两种治疗途径的治疗结果,随访1mo。结果:曲安奈德(TA)玻璃体内注射治疗前后结果比较,各时期无论视力及OCT检查结果均有显著性差异(P<0.01),但其致眼压升高的副作用也较为明显,发生率与国内报道基本相近。曲安奈德Tenon囊球后注射治疗前后比较,无论视力及OCT检查结果均有显著性差异(P<0.01),但其副作用较少。两组患者治疗后各时期OCT检查结果的纵向比较有统计学意义(P<0.05)。结论:曲安奈德(TA)玻璃体内注射和Tenon囊球后注射均对治疗视网膜静脉阻塞黄斑水肿有效,前者疗效更加理想,但副作用明显。后者副作用较少,可反复注射,在治疗复发性黄斑水肿中可联合使用以达到治疗目的。

AIM. To contrast the efficacy and safety between transtenon＇s retrobulbar and intravitreal injection of triamcinolone acetonide treat for retinal vein obstruction patients with macular edema. METHODS. A total of 114 eyes of 114 patients （ male 72 eyes, female 42 eyes ） with retinal vein obstruction macular edema, of them, 66 patients 66 eyes （male 43 eyes, female 23 eyes ） treated with triamcinolone acetonide intravitreal injection was as group A and 48 patients 48 eyes （male 29 eyes, female 19 eyes） with macular edema treated with triamcinolone acetonide trans-tenon＇s retrobulbar injection was as group B. Through observation of visual acuity, intraocular pressure and examination of OCT in two groups, we contrasted the therapeutic result of two treatment pathway. Following-up was for 1 month. RESULTS. In group A, visual acuity and OCT examination result showed significant difference in different period before and after treatment （ P〈 0.01 ）, but the side effect of high intraocular pressure was obvious, the incidence rate was close to domestic report. In group B, visual acuity and OCT examination result also showed significant difference in different period before and after treatment （P〈 0.01 ）, but the side effect was less. The OCT examination result of two groups in different period had statistical significance in length wise contrast （P〈0.05）. CONCLUSION： Triamcinolone acetonide intravitreal and trans-tenon＇s retrobulbar injection are all effective to retinal vein obstruction patients with macular edema, the curative effect of former is better but side effect is obvious. The latter＇s side effect is less and it can be repeated. We can combine these two methods to achieve therapeutic aim of palindromia macular edema.