曲安奈德玻璃体腔注射治疗黄斑囊样水肿

Intravitreal Triamcinolone Acetonide for Cystoid Macular Edema

目的探讨曲安奈德(triamcinolone acetonide,TA)玻璃体腔注射治疗黄斑囊样水肿(CME)的疗效及安全性。方法对18例19眼常规治疗方法无效或效果不佳的黄斑囊样水肿病例玻璃体腔注射TA 4mg。治疗前后行最佳矫正视力、眼压、荧光素眼底血管造影(FFA)和光相干断层扫描(OCT)检查。随访6～13月,平均8.7月。结果治疗前视力为0.14±0.07,治疗后1、3、6月分别提高到0.34±0.15、0.36±0.16、0.32±0.18,与治疗前比较差异均有统计学意义(P<0.01)。治疗后随访末期16眼视力提高,3眼视力无变化。治疗前黄斑中心厚度(CMT)为(525±118)μm,治疗后1、3、6月CMT分别下降到(265±105)μm、(242±129)μm、(288±135)μm,与治疗前比较差异均有统计学意义(P<0.05)。治疗后3月时视力提高及CMT降低最明显,术后6月时视力有所回退,CMT有所增加。术后7眼(36.8%)眼压升高大于2.80kPa。结论曲安奈德玻璃体腔注射是治疗难治性黄斑囊样水肿安全、有效的方法,治疗效果于注药3月时最明显,3个月后治疗效果有所减弱,其远期效果尚须进一步观察。一过性眼压升高是最常见并发症。

Objective To evaluate the efficacy and safety of intravitreal triamcinolone acetonide（TA） for cystoid macular edema（CME）.Methods Eighteen patients（19 eyes） with CME who have failed to respond to conventional therapy were treated with intravitrial injection of 4 mg TA and were followed up for a mean of 8.7 months（range,6 to 13 months）.Best-corrected visual acuity（BCVA）,fundus fluorescein angiography（FFA）,intraocular pressure（IOP） and optical coherence tomography（OCT） were performed before and after treatment.Results The average BCVA increased from 0.14±0.07 before injection to 0.34±0.15,0.36±0.16 and 0.32±0.18 at 1,3 and 6 months after injection,respectively（P0.01）.At the end of follow-up,BCVA was increased in 16 eyes and unchanged in 3 eyes.The average central macular thickness（CMT） decreased from（525±118） μm before injection to（265±105）μm,（242±129）μm and（288±135）μm at 1,3 and 6 months after injection,respectively（P0.05）.The BCVA and CMT were obviously improved at 6 months after injection,but were regained after 6 months.In addition,intraocular pressure exceeded 2.80 kPa in 7 eyes（36.8%）.Conclusion Intravitreous injection with TA is safe and effective for CME,which is often complicated by temporary increase in IOP.The therapeutic effect is most obvious at 3 months after injection,but is weakened after 3 months.Moreover,further study is needed to assess the long-term efficacy.