曲安奈德治疗重度糖尿病黄斑水肿的临床观察

Clinical Effects of triamcinolone acetonide for serious macular edema diabetic

目的研究玻璃体腔内注射曲安奈德(TA)治疗重度糖尿病黄斑水肿的有效性。方法对36例(42眼)重度糖尿病黄斑水肿的患者,行玻璃体腔内注射TA(进口)(4mg/0.1ml)的治疗方法。观察治疗前后的四个指标:最佳矫正视力、眼压、眼底荧光血管造影(FFA)、OCT检测黄斑中心凹厚度。随访时间6～12个月(平均9个月)。结果本组病例36例(42眼),年龄45～70岁(平均57岁),FFA检查治疗前黄斑荧光渗漏明显,治疗后渗漏明显减轻;OCT检测黄斑中心凹厚度,治疗前平均(579.5±65)μm,治疗随访6个月后平均(279±78)μm,差异有统计学意义(P<0.05);最佳矫正视力范围治疗前为0.01～0.2,平均0.1,治疗后为0.2～0.4,平均0.3,差异有统计学意义(P>0.05);所有患者眼压都有升高,升高值8.0～20.0mmHg(平均14.0mmHg),7例(7眼)超过正常眼压范围,经治疗,眼压控制,没有严重并发症发生。结论玻璃体腔注射TA是治疗重度糖尿病黄斑水肿的有效方法,患者的视力有轻度提高,治疗后患者FFA,黄斑区荧光素渗漏明显减轻,OCT检查,证实黄斑厚度明显减小。

Objective To evaluate the therapeutic effect of intravitreal injection of triamcinolone ace- tonide （TA）in the treatment for serious diabetic macular edema. Methods A total of 36 patients（42 eyes）di- agnosed with serious macular edema diabetic. These patients underwent intravitreous injection of triamcinolone acetonide （import） （4 mg/0. 1 ml）. Observation of before and after treatment four indicators：best corrected vis- ual acuity, intraocular pressure （IOP） ,fundus fluorescence angiography（FFA） and optic coherence tomography （OCT）. The foUow-up period ranged from 6 months to 12 months average 9 months. Results The 36 patients （42 eyes） age of patients ranged from 45 to 70 （mean 57） years. Before treatment FFA showed leakage signifi- cantly, after treatment significantly reduced leakage. The macular foveal thickness was （579. 5 ± 65 ） μm on av- erage measured by 0 cT before the treatment and decreased to a mean of （265 ±78） μm at 6 months after injec- tion of TA （ P 〈 0.05 ）. The mean postoperative bestcorrected visual acuity wag）. 01 ~ 0. 2, average 0. 1, after treatment for0.2 ~ 0. 4, average 0. 3 （ P 〉 0.05 ）. The IOP of all patients were increased, and the scope of IOP elevation was from 8 to 20. 0 （mean 14）mm Hg. 7 cases （7 eyes）beyong the normal intraocular pressure range, after treatment IOP were control, no serious complications occurred. Conclusion Intravitreal triamcinolone acetonide injection seems to be a promising treatment option for serious diabetic maeular edema, visuaI acuity of patients with mild improvement, after treatment FFA showed, the macular area of fluorescein leakage significantly reduced, OCT examination confirmed the macular thickness decreases.