经晶状体后囊膜玻璃体腔注射曲安奈德联合白内障超声乳化术治疗白内障合并黄斑水肿

Trans-posterior lens capsule intravitreal with triamcinolone acetonide injection combined with phacoemulsiffcation for treatment of patient with cataract and macular edema

目的探讨通过一次性手术在进行白内障超声乳化联合人工晶状体植入术术中经晶状体后囊膜向玻璃体腔注射曲安奈德(TA)治疗白内障合并黄斑水肿的安全性和有效性。方法对20例(23只眼)实施白内障超声乳化联合人工晶状体植入术,术中经晶状体后囊膜向玻璃体腔注射TA 4 mg/0.1 ml,观察手术前和手术后第1周、1、3、6个月患者的最佳矫正视力(BCVA)及眼压变化,并通过相干光断层扫描仪(OCT)测量黄斑中央凹厚度(CFT)的变化。结果 23只眼平均LogMAR BCVA与术前相比均有显著提高(P<0.05)。手术后1周、1、3、6个月黄斑中央凹平均厚度与手术前相比,差别有统计学意义(P<0.05)。23只眼中有3只眼(13.0%)于术后1个月出现暂时性眼压升高,予以局部用药后眼压正常。23只眼中无玻璃体积血、视网膜脱离和感染性眼内炎等严重并发症发生。结论在一次手术中采用经晶状体后囊膜玻璃体腔注射TA联合白内障超声乳化术治疗白内障合并黄斑水肿是安全、有效的。

Objective To investigate the safety and efficacy of trans-posterior lens capsule intravitreal with triamcinolone acetomide injection combined with phacoemulsification for treatment of patient with cataract and macular edema in one operation. Methods This study involved 23 eyes of 20cases. An intravitreal injection of triamcinolone acetomide at the dose of 4mg/0. 1ml was administered trans-posterior lens capsule in the process of phacoemulsification and intraocular lens implantation. Best-corrected visual acuity（BCVA） , intraocular pressure （IOP） and central fovea thickness（CFT） measured by optic coherent tomography （ OCT） were recorded preoperatively and 1 week,1 month, 3 months, and 6 months postoperatively. Differences of measurements were evaluated by T-test using spss 13.0. Results Mean best-corrected Log- Mar visual acuity in 23 eyes improved significantly from baseline at the 1 week, lmonth, 3months, and 6months postoperatively followup intervals（ P 〈0.05）. The mean central fovea thickness （CFT） which was obtained from 1 week,1 month, 3 months,6 months postoperatively was significantly different from the baseline measurement （ P 〈0.05 ）. During the follow-up ,three（ 13.0% ）eyes developed temporary higher intraocular pressure which was controlled by topical medicine. No severe complications such as vitreous hemorrhage,retinal detachment and endophthalmitis were fund. Conclusion Transposterior lens capsule intravitreal with triamcinolone acetomide injection combined with pbacoemulsification for treatment of patient with cataract and macular edema in one operation is a safe and effective approach.