玻璃体内注射曲安奈德治疗DME的投药剂量研究

Dosage study of intravitreous injection with triamcinolone acetonide for DME

目的:寻找玻璃体内注射曲安奈德(TA)治疗糖尿病性黄斑水肿(diabeticmacularedema,DME)的最小有效剂量。方法:选择FFA证实为DME的患者38例45眼,将其随机分为两组:A组19例22眼,B组19例23眼。两组分别采用40g/L的TA2mg和4mg玻璃体内注射。治疗前两组的平均最佳矫正视力(BCVA)分别为0.06±0.06和0.06±0.05(t=0.076,P=0.94),并且眼压<21mmHg。用药后随访6mo,对比观察用药前后的视力、眼压、晶状体和眼底改变以及FFA表现。结果:治疗后平均BCVA:A组22眼为0.13±0.05,B组23眼为0.12±0.04;两组患者治疗前后比较差异均有统计学意义(t=-4.39,P=0.00;t=-5.75,P=0.00)。用药后眼压>21mmHgA组2眼(9%),B组9眼(39%),高眼压发生率的差异有统计学意义(χ2=3.99,P=0.04)。FFA显示治疗有效A组为19眼,B组22眼,两组有效率差别无统计学意义(χ2=0.32,P=0.56)。在6mo内复发率A组5眼(23%),B组3眼(13%),其差异无统计学意义(χ2=0.21,P=0.64)。两组中均无发生难治性青光眼和白内障发展眼。黄斑水肿复发眼再次玻璃体内注射TA有效。结论:玻璃体内注射TA2mg或4mg对于DME均有一定疗效,其短期复发率没有明显差异。玻璃体内注射2mgTA较注射4mg能较少引起眼压升高。

AIM：To look for the minimum effective dosage of intravitreal injection with triamcinolone acetonide（TA） for diabetic macular edema（DME）.METHODS：A total of 45 eyes in 38 DME patients who were diagnosed by FFA were collected.They were divided into two groups：22 eyes in group A and the other 23 eyes in group B.Different dosage of 40g/L TA（2mg or 4mg） were respectively used for intravitreal injection for the two groups.Before the treatment,the average best-corrected visual acuity（BCVA） was 0.06±0.06 and 0.06±0.05 in the two groups respectively（t=0.076,P=0.94）,and all the intraocular pressure（IOP） was below 21mmHg.The average follow-up duration was 6 months after treatment.The BCVA,IOP,changes of lens and ocular fundus and FFA before and after treatment were observed.RESULTS：The average BCVA after treatment was 0.13±0.05 and 0.12±0.04 in the two groups respectively.The differences caused by treatment for each group were statistically significant（t=-4.39,P=0.00;t=-5.75,P=0.00）.The hypertension rate was 9%（2 eyes） in group A and 39%（9 eyes） in group B（χ2=3.99,P=0.04）.For 19 eyes in group A and 22 eyes in group B,the treatment showed effective by FFA（χ2=0.32,P=0.56）.The recurrence rate was 23% and 13% respectively,the difference was not statistically significant（χ2=0.21,P=0.64）.No refractory glaucoma and cataract development eye occurred.Intravitreous injection with TA again was effective if macular edema recurred.CONCLUSION：No matter the dosage is 2mg or 4mg,intravitreous injection with TA is a promising therapeutic method for DME,its short-term recurrence rate is not obviously different.But 2mg TA injection may cause less increased IOP than 4mg TA injection.