TA联合全视网膜光凝治疗糖尿病性黄斑水肿的效果评价

Evaluation of the TA combined with Panretinal photocoagulation in treating the diabetic macular edema

目的评价玻璃体腔内注射曲安奈德（TA）联合全视网膜光凝（PRP）治疗糖尿病性黄斑水肿的效果。方法将诊断为糖尿病性黄斑水肿的31例患者31只患眼，随机分为PRP治疗组（对照组）16例16只眼和IVTA联合PRP治疗组（联合组）15例15只眼，治疗后1月、3月、6月分别检查并记录患者的最佳矫正视力（BCVA）、眼压（IOP）、眼底荧光血管造影（FFA）、光学相干断层扫描（OCT）、眼前节及眼底情况等，相关数据应用SPSS进行t-检验、直接概率计算法、重复设计的方差分析。结果（1）联合组PRP治疗后3个月、6个月BCVA高于对照组（P〈0．05）；（2）联合组PRP治疗后1个月、3个月视网膜新生血管（RNV）渗漏面积小于对照组（P〈0．05），6个月后差异无统计学意义（P〉0．05）；（3）联合组PRP治疗后1个月、3个月、6个月黄斑中心区视网膜厚度（CMT）值低于对照组（P〈0．05）；（4）联合治疗组所需激光能量低于对照组（P〈0．01）；（5）两组IOP值差异无统计学意义（P〉0．05）。结论玻璃体腔注射TA联合全视网膜光凝治疗糖尿病性黄斑水肿可以降低PRP所需能量，减少PRP对视网膜的损伤，减轻延缓水肿，提高视力，是一种值得推荐的糖尿病黄斑水肿的治疗方法。

Objective To evaluate the effect of intravitreal injection with triamcinolone acetonide （TA） combined with all Panretinal photocoagulation （PRP） in treating the diabetic macular edema. Methods Thirty-one patients with 31 eyes in diabetic macular edema were chosen. Patients were randomly divided into two groups, which were the PRP treatment group, and IVTA plus PRP group. The combined treatment group completed IVTA 4mg （0.1ml） in 7 days after PRP treatment, a total of 4 times per week, the PRP treatment group was only treated with PRP alone, a total of 4 times per week. All patients in the two groups were return visit, and checked the BCVA, IOE FFA, OCT, anterior segment and fundus after 1 month, 3 months, and 6 months. All the data used the statistical analysis methods by the SPSS data applications, including the t-test, the direct probability calculation, and repeated design analysis of variance. Results The average best corrected visual acuity in the combined treatment group were higher than the PRP treatment group 3 months and 6, months after treatment （P 〈0.05）. The RNV leakage area was significantly lower in the combined treatment group after treatment of 1 month and 3 months （P 〈0.05）, but was not significant after 6 months （P 〉0.05）. The macular retinal thickness values lowered in the joint group after 1 month, 3 months, 6 months （P 〈0.05）. The combined treatment group required lower laser energy than the PRP treatment group （P 〈0.01）. The IOP in both groups were no different （P 〉0.05）. Conclusions Intravitreal injection of TA combined with all retinal photocoagulation is a good way in treat the diabeticmacular edema, which can reduce the energy needed for PRP, reduce the delay edema, and improve vision, which is a worthy recommendation in treating the diabetic macular edema.