曲安奈德在儿童眼内炎玻璃体切割手术中的应用

Application of triamcinolone acetonide in vitrectomy for endophthalmitis in childhood

目的评价曲安奈德(TA)在儿童眼内炎玻璃体切割手术中的应用及疗效。方法回顾性分析2003年1月—2008年2月在厦门大学附属厦门眼科中心行巩膜外环扎术+玻璃体切割+TA注射联合硅油填充术的54例56眼儿童眼内炎患者的临床资料,并根据手术中是否玻璃体腔注射TA分为2组:A组29例29眼;B组25例27眼。术后随访(24.3±12.2)个月,按照患者视力改善情况和视网膜复位情况评估手术效果,并根据术后并发症的情况评价TA在玻璃体切割手术中应用的安全性。结果 54例56眼患者出院时眼内炎症均得到控制,脱离的视网膜均解剖复位。除3眼视力检查不合作外,术后视力提高42眼,其中A组26眼(26/29,占89.66%),B组16眼(16/27,占59.26%),2组比较差异有统计学意义(χ2=6.890,P=0.009)。37眼术后矫正视力>0.05,其中A组23眼(23/29,占79.31%);B组14眼(14/27,占51.85%),2组比较差异有统计学意义(χ2=4.703,P=0.030)。14眼患者玻璃体切割术后继发视网膜脱离,其中A组4例4眼,发生率为13.79%,B组9例10眼,发生率为37.04%,2组比较差异有统计学意义(χ2=4.029,P=0.045)。结论儿童眼内炎玻璃体切割手术过程中应用TA可明显改善患者的视力预后,有效预防玻璃体切割手术后视网膜脱离等并发症的发生,提高了手术的安全性和成功率。

Background Endophthalmitis is a common cause of blindness for children,and vitrectomy is effective in treating endophthalmitis. As a long-acting glueocorticoid, triameinolone aeetonide （TA） has been widely applied in the vitreoretinal surgery. Objective This study was to evaluate the clinical efficacy of triamcinolone aeetonide （TA） application during the vitrectomy of endophthalmitis in children. Methods The clinical data of 56 eyes from 54 children undergone cerclage selera ＋ vitrectomy ＋ intraocular photocoagulation and silicone oil tamponade for endophthalmitis in Affiliated Xiamen Ophthalmic Center of Xiamen University from Jan,2003 to Feb,2008 were collected and analyzed. The patients were assigned to two groups, group A included 29 cases （29 eyes） and in group B 25 cases （27 eyes） was selected according to whether the TA was injected intravitreally during the vitrectomy. The effectiveness of vitrecomy in this study was evaluated by assessing the visual acuity and attachment of retina,and the safety of the intravitreal injection of TA was analyzed according to the occurrence of complications. All the patients were followed-up over 12 months after the vitrectomy. Results The ocular inflammation was faded and retina was attached in all the cases after operation. The visual acuity was improved in 42 eyes except 3 children with poor collaboration in the examination of visual acuity,the improved vision acuity included 26 eyes （89.66%） in group A and 16 eyes （59.26%） in group B, showing a significant difference between them （χ^2= 6. 890, P = 0. 009 ）. In 37 eyes the visual acuity was 〉 0.05, which included 23 eyes （79.31%） in group A and 14 eyes （51.85%） in group B with statistically significant difference （χ^2 = 4. 703 ,P = 0. 030）. Retinal detachment was occurred in 14 eyes of 13 cases after vitrectomy with the incidence 13.79% in group A and 37.04% in group B, showing a statistically significant difference between them （χ^2= 4. 029,P = 0. 045 ）. Conclusion The application of TA in vitrectomy is effective in the treatment of endophthalmitis in children. It can significantly improve the visual prognosis of the children with endophthalmitis and prevent the complication after vitrectomy of endophthalmitis in children.