曲安奈德和激光治疗静脉阻塞性黄斑水肿

Effect of triamcinolone acetonide and laser photocoagulation for macular edema of retinal vein occlusion

目的:观察并对比玻璃体腔注射曲安奈德(TA)和激光光凝治疗视网膜静脉阻塞性黄斑水肿的效果,探讨两者联合治疗的必要性及联合治疗的时机。方法:对非缺血型分支静脉阻塞累及中心凹且有灌注的黄斑水肿(中央视网膜厚度≥300μm)患者,随机分为TA组和激光组,采用双盲法进行前瞻性治疗。TA组(46眼)玻璃体腔注射曲安奈德4mg,激光组(44眼)行血管弓内格栅样光凝及无灌注区播散光凝。采用最佳矫正视力(BCVA)和相干光断层扫描(OCT)作为评价两种方法治疗前后不同时期疗效的主要指标,应用独立样本t检验对数据进行统计学处理。结果:中央视网膜厚度介于300～500μm,1wk～1mo时TA组改善视力和减轻黄斑水肿的程度较激光组非常显著;1～3mo时TA组治疗效果随时间延长呈缓慢下降趋势,而激光组呈缓慢稳定上升趋势;6mo时TA组和激光组治疗效果无显著差异;6moTA组个别患者黄斑水肿复发需再次注射。结论:对于视网膜分支静脉阻塞性黄斑水肿中央视网膜厚度介于300～500μm,玻璃体腔注射TA及激光光凝均可以选择;对中央视网膜厚度≥500μm患者可采用联合治疗,TA联合光凝治疗的时机应在玻璃体腔注射TA后1wk～1mo内积极进行;玻璃体腔注射TA后黄斑水肿复发,再次注射需间隔6mo以上。

AIM：To observe and compare the effect of intravitreous injection of triamcinolone acetonide（TA） and laser photocoagulation for macular edema in branch retinal vein occlusion（BRVO）,and to investigate the necessity and time point for combination of two therapies.METHODS：The patients with macular edema of non-ischemia BRVO were divided randomly into TA group（46 eyes） and laser group（44 eyes）,and were treated with double blind method.TA group underwent intravitreous injection TA（IVTA） 4mg,laser group was with grid photocoagulation within blood vessels arch and spot photocoagulation in nonperfusion area.The patients＇ best-corrected visual acuity（BCVA） and central retinal thickness（CRT） by optic coherence tomography（OCT） in different time of pre-and post-therapy were examined and the data were analyzed by independent sample t test.RESULTS：：One week to one month after treatment,the improvement of BCVA and CRT in TA group were significant better than those in laser group in patients whose initial CRT were 300-500μm.One to three months after treatment,the improvement in TA group dropped down slowly,while the improvement in laser group increased gradually.Six months after treatment,there was no significant difference between TA group and laser group.A few patients in TA group needed re-injection due to recurred macular edema.CONCLUSION：Both IVTA and laser photocoagulation could be used in BRVO whose CRT ranged 300-500μm;The patients with CRT larger than 500μm could be treated by combined therapy of IVTA followed by laser grid photocoagulation 1 week-1 month later.Recurrence of macular edema after IVTA could be injected TA again six months after first injection.