球周及眼内注射曲安奈德对脉络膜脱离型视网膜脱离预后的影响

The impact of periocular and intraocular in jection of triamcinolone acetonide on the prognosis of retinal detachment with choroi dal detachment

目的探讨球周及眼内注射曲安奈德对脉络膜脱离型视网膜脱离预后的影响。方法将脉络膜脱离型视网膜脱离29眼随机分为:眼内硅油填充+曲安奈德(TA)玻璃体腔注射(A组,15眼),眼内C3F8填充+TA半球后注射(B组,14眼)。术前均以40 mg甲泼尼龙半球后注射。术毕A组以硅油填充且眼内注入4 mg TA,B组以C3F8填充且40 mg TA半球后注射。比较两组间最佳矫正视力、视网膜复位率的差异。结果第1次手术视网膜复位率A组(86.67%)高于B组(71.43%),但差异无统计学意义(P=0.390);术后增生性玻璃体视网膜病变发生率B组(28.57%)高于A组(13.33%)且增生性玻璃体视网膜病变严重程度更高。A组中有11眼,B组中有10眼术后最佳矫正视力提高,差异无统计学意义。结论玻璃体切除联合TA眼内注射及硅油眼内填充对脉络膜脱离型视网膜脱离的视网膜复位更好一些,尤其对于一些特殊患者如患有糖尿病、高血压及消化道溃疡,可能是一种更好的选择。

Objective To study the impact of periocular and intraocular injectionof triamcinolone acetonide （TA） on the prognosis of retinal detachment with choroidal detachment. Methods Twenty-nine eyes of retinal detachment with choroidal detach- ment were treated by PPV along with triamcinolone acetonide （TA） intravitreal injec- tions and silicone oil intraocular tamponade（ group A, 15 eyes）, or TA periocular injec- tions and C3F8 intraocular tamponade （group B, 14 eyes）. The two groups are all re- ceived 40 mg methylprednisolone periocular injections before surgery. After the surgery, silicone oil intraocular tamponade and 4 mg TA intravitreal injections were performed on group A, while C3 F8 intraocular tamponade and 40 mg TA periocular injections on group B. Anatomic reattachment of the retina and the best-corrected visual acuity were measured. Results The rate of retinal reattachment was higher in the eyes of group A （85. 57% ）than that in group B（71.4% ） in the first operation,but the difference has no statistical significance （ P = 0,390 ） ; the incidence rate of proliferative vitreoretinopathy （PVR） after the operation were higher in eyes of group B （28.57%） than that in groupA （13.33%）,what＇s more,the severity of PVR is also higher. The functional outcome is that, 11 eyes in group A and 10 eyes in group B achieved improvement in best corrected visual acuity（BCVA） after operation, and no significant difference between them. Conclusion PPV along with silicone oil intraocular tamponade and TA intravitreal injection were effective to the retinal reattachment of retinal detachment with choroidal detachment, and perhaps it is a better choice for the pa- tients with other diseases like diabetes mellitus,hypertension and gastrointestinal ulcer.