曲安奈德玻璃体腔注射治疗黄斑水肿的临床观察

Clinical Observation of the Triamcinolone Acetonide Vitreous Injection Macular Edema

目的观察玻璃体腔内曲安奈德（triamcinolone acetonide,TA）注射治疗各种黄斑水肿（macularede-ma）的疗效和安全性。方法回顾性分析玻璃体腔注射曲安奈德治疗黄斑水肿108例122眼,术前视力指数至0.4。其中由糖尿病视网膜病变引起的弥漫性黄斑水肿或囊样水肿50例64眼,由视网膜静脉阻塞引起者58例58眼。通过眼部基础检查（视力、眼压、裂隙灯显微镜、双目间接检眼镜）、眼底荧光血管造影证实黄斑水肿。所有病例均玻璃体腔一次性注射曲安奈德混悬液0.1 mL（4 mg）。术后随访3~6个月,观察视力、眼压、双目间接检眼镜、眼内炎症反应及晶状体改变,复查眼底荧光血管造影观察黄斑水肿的变化。结果术后2周时视力提高3行以上者95眼（占77.87%）,提高3行以内者20眼（占16.39%）,不变者7眼（占5.74%）。术后3个月时视力提高3行以上者107眼（占87.7%）,提高3行以内者8眼（占6.56%）,不变者7眼（占5.74%）。与治疗前比较,差异有统计学意义（P〈0.05）。所有患者治疗后黄斑水肿均减轻或者消退,考虑视力不变的7眼因为黄斑水肿时间长,甚至囊样变性。但有3眼（占0.02%）治疗后4~6个月出现黄斑水肿复发（均为糖尿病者）,给予再次曲安奈德注射。15眼（占12.3%）注射后1~2W出现眼压升高至22~26 mmHg,经对症降眼压眼药水治疗后均下降至正常眼压。无玻璃体出血、视网膜脱离、继发白内障和眼内炎等严重并发症发生。结论曲安奈德玻璃体腔内注射可以促使黄斑水肿消退或减轻,提高患者的视功能,除少数几例眼压升高外,无其他并发症发生,是一种有效且安全可行的方法。对黄斑水肿时间长,甚至囊样变性的患者,临床尚需研究比此更好的治疗方法。

Objective To observe vitreous TA of macular edema therapy＇s efficacy and safety.Methods TA injections were analyzed retrospectively macular edema,108 cases of 122 eyes,one of the causes of diabetic retinopathy diffuse macular edema or cystic edema 50 cases of 64 eyes,the retinal vein obstruction caused by 58 cases of 58 eyes.After tested the eye foundation visual acuity intraocular pressure,slit lamp microscope,binocular indirect ophthalmoscope,funduscopy fluorescence angiographic macular edema,all cases were six one-time injection TA suspension liquid 0.1 ML（4mg）.Follow-up of 3~6 months,observed visual acuity intraocular pressure,binocular indirect ophthalmoscope,intraocular inflammation and lens change,reviewed fundus fluorescence angiographic observations macular edema.Results After two weeks,there were 95 eyes＇（77.87%） visual acuity increased 3 lines,within 3 lines were 20 eyes（16.39%）,the same were 7 eyes（5.74%）.Postoperative visual acuity after 3 months,there were 107 eyes increased more than 3 lines（87.7%）,and within 3 lines were 8 eyes（6.56%）,the same were 7 eyes（5.74%）.Compared with pre-therapy,difference was statistically significant（P0.05）.After treatment all patients were mitigated or subsidise macular edema,and consider the vision unchanged for macular edema 7 eyes,even longer cystic degeneration.But there were three eyes（0.02%） TA injection again after receiving 4 ~ 6 months macular edema（diabetes）.After two weeks 15 eyes（12.3%） injection appeared length from one to 22~26mmHg elevated iop.After suiting drop eyedrop intraocular pressure,were dropped to normal intraocular pressure.There were no the vitreous hemorrhage,retinal detachment,secondary cataracts and endophthalmitis severe complications.Conclusions TA vitreous injection can make macular edema retreat or mitigate,improve patient visual function,except for a few cases elevated intraocular pressure,and no complications,is a safe and effective method.For macular edema,or even longer cystic degeneration patients,and clinical studies should research a better treatment.