玻璃体切除联合曲安奈德治疗糖尿病性黄斑水肿的研究

Clinical study on effects of vitrectomy with triamcinolone acetonide(TA) on diabetic macular edema

目的观察玻璃体切除手术联合曲安奈德(TA)应用治疗糖尿病性黄斑水肿的疗效,视力和黄斑中心凹厚度的变化以及对眼压的影响。方法选取糖尿病视网膜病变(Ⅲ,Ⅳ,Ⅴ期)引起的黄斑水肿60例(60眼)。随机分成观察组和对照组各30例。观察组行玻璃体切除手术,术中应用TA标记,术毕留置4 mg TA于玻璃体腔内;对照组行单纯玻璃体切除手术。结果视力:观察组与对照组术后4个月时视力均优于术前视力,差异具有统计学意义,两组之间对照,前者的视力恢复优于后者,(P<0.05)具有统计学意义。黄斑中心凹OCT值:观察组与对照组术后4个月黄斑中心凹OCT值与术前对照P<0.01具有统计学意义。两组之间对照P<0.05,具有统计学意义。眼压:观察组与对照组术后14 d内眼压与术前相对照P<0.05,具有统计学意义,术后4个月时眼压P>0.05,无统计学意义;术后14 d内,两组之间对照,P>0.05无统计学意义。结论单纯玻璃体切除手术治疗治疗黄斑水肿有效;玻璃体切除联合TA应用治疗黄斑水肿疗效显著,后者疗效优于前者。两种手术方法对眼压均有一定的影响,应引起重视,以免造成视功能损害,但两种方法之间无差异。

Objective To evaluate the effects of pars plana vitrectomy with TA in diabetic macular edema by observing changes of visual acuity,thickness of central fovea of macula,and intraocular pressure. Methods We selected 60 eyes with diabetic macular edema（without cataract,glaucoma and ametropia） by three mirror lens,FFA and OCT.They were divided into two groups： study group（30 eyes） and control group （30 eyes）.In the study group,30 eyes underwent pars plana vitrectomy with TA marker,in the end of operation,4mg TA were injected into the vitreous cavity.The control group,all eyes received simple pars plana vitrectomy. Results 1.Visual acuity： In the study group and control group,postoperative（4months） were significantly higher than preoperative;There were significant difference between the two groups（P〈0.05）.2.The thickness of central fovea of macular（OCT）： In the study group and control group,the thickness of central fovea of macular of 4 months after operation were less than preoperative（P〈0.01）.There was significant difference between the two groups（P〈0.05）.3.Intraocular pressure： In the study group and control group,the intraocular pressure on 14 days after operation were higher than preoperative （P〈0.05）;While there was no difference between 4 months later and preoperative（P〈0.05）.On 14 days after operation,there was no difference between the two groups（P〈0.05）. Conclusion Simple pars plana vitrectomy is effective for diabetic macular edema;Vitrectomy with triamcinolone acetonide have significant curative effect for them;the latter is better than the former.Both of them influenced the intraocular pressure,so we should pay attention to that in order to avoid damage of visual function,but there is no difference between two methods.