玻璃体腔注射曲安奈德术后并发症的治疗

MANAGEMENT OF COMPLICATIONS AFTER INTRAVITROUS INJECTION OF TRIAMCINOLONE ACETONIDE

目的观察玻璃体腔注射曲安奈德(TA)术后常见并发症的治疗及预后。方法对玻璃体腔注射TA的92只眼分别于术后第1、3、7、30、60、90天行眼压、视力、裂隙灯及间接眼底镜检查,术前及术后30 d行眼底血管荧光造影及光学相干断层扫描。结果92只眼中,术后眼压高者19只眼,给予5 g/L噻吗洛尔眼液点眼,7 d后14只眼眼压恢复正常;2只眼控制在4 kPa以下,持续用药2个月后降至正常;3只眼眼压在注药后2个月才出现高眼压,联合用药后1只眼眼压仍在3.47～4.67 kPa。8只眼术后第1天出现前房闪辉,第2天消失。2只眼术后第1天出现前房积脓,玻璃体腔混浊,经局部及全身抗炎治疗,局部应用复方托吡卡安散瞳,1周后炎症消退。3只眼术后第1天发现视网膜局部小片状出血。本组病人未出现视网膜脱离、玻璃体积血、白内障等严重并发症。5只眼在注药后3个月黄斑水肿复发,给予二次注药。结论玻璃体腔注射TA后并发症主要有高眼压、炎症反应、视网膜毒性及黄斑水肿复发,应引起高度重视。

Objective To observe the treatment and prognosis of complications caused by intravitreous injection of triamcinolone acetonide （TA）. Methods The visual acuity, intraocular pressure （IOP） and fundus were examined on 92 eyes on day 1, 3, 7, 30, 60 and 90 after intravitreous injection of TA. Fundus fluorescence angiography and optical coherence tomography were checked before and on day 30 after the injection. Results The IOP of 19 eyes （20.7%） were higher than 2.8 kPa （21 mmHg）, of which, 14 eyes returned to normal seven days after 0.5% timolol administration, two eyes returned to normal after two months. Three eyes showed high IOP two months after injection. After combination therapy, the IOP of one eye was still at 3. 47 -- 4.67 kPa （26--35 mmHg）, eight eyes showed aqueous flare one day after TA injection, but the syraptom disappeared the next day. Two eyes showed hypopyon and vitreous opacity. With systemic and local antibiotic, the inflammation disappeared after one week. Three eyes showed retinal hemorrhage. Five eyes which had macular edema recurred after three months, and received second TA injection. There was no severe complications such as retinal detachment, vitreous hemorrhage and cataract. Conclusion The main complications after intravitreous injection of triamcinolone acetonide are high fOP,inflammation, retinal toxicity, and macular edema. A great attention should be paid on them.