球后注射曲安奈德治疗视网膜静脉阻塞继发黄斑水肿

Retrobulbar injection with triamcinolone acetonide for macular edema caused by retinal vein occlusion

目的观察球后注射曲安奈德(TA)治疗不同类型视网膜静脉阻塞(RVO)所致黄斑水肿的临床疗效。设计同顾性病例系列。研究对象不同类型RVO继发黄斑水肿的患者21例21眼。方法患者均经球后注射TA 40mg,随访观察不同类型、不同病程RVO致黄斑水肿治疗前后的视力、眼压、荧光素眼底血管造影(FFA)和相干光断层扫描(OCT)检测黄斑水肿的变化情况。随访6～11个月。主要指标视力、黄斑中心凹平均厚度。结果到最后一次随访时,视力提高16眼(76.2%),视力不变5眼(23.8%)。治疗前及最后一次随访时黄斑中心凹平均厚度(617.23±185.58)μm、(287.55±121.70)μm(P=0.000)。治疗后CRVO组与BRVO组之间、缺血型组与非缺血型组之间,无论是视力还是黄斑中心凹平均厚度的变化的比较,差异均无明显统计学意义(P>0.05);病程≤3个月以及3～6个月的患者治疗前后的视力差异有统计学意义(P值分别为0.011,0.01),病程≥6个月的患者治疗前后的视力差异无明显统计学意义(P=0.583)。FFA显示治疗后黄斑区荧光素渗漏明显减轻。所有患者随访期间眼压均≤21mmHg。8例患者治疗后2～6个月黄斑水肿复发。结论球后注射TA可有效治疗RVO引起的黄斑水肿,操作简便且安全性高,早期治疗效果好。

Objective To evaluate the therapeutic efficacy of retrobulbar injection with triamcinolone acetonide （TA） for macular edema caused by retinal vein occlusion （RVO）. Design Retrospective case series. Participants 21 eyes of 21 patients with macular edema caused by RVO. Methods Retrobulbar injection with TA 40 mg was performed on 21 eyes. The visual acuity, intraocular pressure, fundus fluorescein angiography （FFA） and macular central thickness under the optical coherence tomography （OCT） were recorded and analyzed before and after treatment. The follow-up duration was 6-11 months. Main Outcome Measures The visual acuity and the maeular central thickness of OCT. Result Visual acuity was improved at the end of follow-up in 16 eyes （76.2%） and unchanged in 5 eyes （23.8%）. Macular central thickness was （287.55±121.70） μm at the end of follow-up and （617.23±185.58） μm before treatment. The difference was statistically significant（P=0.000）. After treatment, the comparison of visual acuity and macular central thickness between CRVO patients and BRVO patients, as well as between ischemic RVO patients and non-ischemic RVO patients had no significant difference （P〉0.05）. In patients of course less than 6 months, the visual prognosis after treatment is better than that of before treatment （P=0.011, 0.01）, while in patients of course more than 6 months, no difference of vision could be detected before and after treatment （P= 0.583）. The result of FFA showed decrease of fluorescein leakage. During follow-up, intraocular pressure of all patients was in the normal range. Recurrence of maeular edema was found in 8 eyes 2 to 6 months after treatment. Conclusions Retrobulbar injection with TA is a safe, effective, and easy method to treat macular edema caused by RVO. Early treatment can get better efficacy. （Ophthalmol CHN, 2009, 18： 254-256）