曲安奈德玻璃体内注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿的临床观察

Triamcinolone acetonide vitreous injection associated with macular grid photocoagulation for macular edema in diabetic retinopathy

目的评价玻璃体内注射曲安奈德(triamcinolone acetonide,TA)联合黄斑部格栅样光凝治疗糖尿病性弥漫性黄斑水肿的治疗效果。方法将51例(56眼)糖尿病性弥漫性黄斑水肿患者随机分为2组,单纯黄斑部格栅样光凝组和联合治疗(玻璃体内注射TA联合黄斑部格栅样光凝)组,每组28眼。其中联合治疗组在注药后1个月行黄斑部格栅样光凝。分别观察2组患者激光后3个月、6个月最佳矫正视力、黄斑厚度、眼压、眼底改变及并发症情况。结果治疗后3个月单纯治疗组和联合治疗组最佳矫正视力分别为0.19±0.15、0.22±0.15,2组黄斑厚度分别为(321.23±112.43)μm、(267.80±104.11)μm,2组间视力和黄斑厚度比较差异有统计学意义(均为P<0.05);治疗后6个月单纯治疗组和联合治疗组最佳矫正视力分别为0.18±0.14、0.29±0.14;2组黄斑厚度分别为(337.62±97.21)μm、(245.21±99.46)μm,2组间视力和黄斑厚度比较差异有显著统计学意义(均为P<0.01)。观察期间联合治疗组7眼出现眼压升高,药物治疗3～7d恢复正常;1眼患者晶状体后囊下明显混浊。结论 TA玻璃体内注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿,短期内黄斑水肿减轻明显、视力提高,但远期疗效、水肿、复发率及并发症等仍需进一步长期观察。

Objective To evaluate the effects of triamcinolone acetonide（TA） vitreous injection associated with macular grid photocoagulation for diabetic diffusive macular edema.Methods Fifty-one patients（56 eyes） with diabetic diffusive macular edema was divided randomly into single macular grid photocoagulation group（single treatment group） and TA vitreous injection associated with macular grid photocoagulation group（associated treatment group）,28 eyes in each group.Patients in associated treatment group were treated with macular grid photocoagulation at 1 month after TA vitreous injection.The best corrected visual acuity（BCVA）,macular thickness,intraocular pressure,fundus changes and complications in two groups were observed at 3 months,6 months after treatment.Results At 3 months after treatment,BCVA in single treatment group and associated treatment group were 0.19±0.15 and 0.22±0.15,respectively;Macular thickness was（321.23±112.43）μm and（267.80±104.11）μm,respectively;There were statistical differences between two groups（both P0.05）.At 6 months after treatment,BCVA in single treatment group and associated treatment group were 0.18±0.14 and 0.29±0.14,respectively;Macular thickness was（337.62±97.21）μm and（245.21±99.46）μm,respectively;There were significant differences between two groups（both P0.01）.During the follow-up in associated treatment group,the intraocular pressure increased in 7 eyes,and recovered after drug treatment from 3 days to 7 days;The opacifiction under lens capsule got worse obviously in 1 eye.Conclusions TA vitreous injection associated with macular grid photocoagulation for diabetic diffusive macular edema can achieve the better visual acuity,and decrease the macular edema in short term,but need a long follow up for the long-term effects,edema changes,recurrence rate and complication.