糖尿病黄斑水肿患者白内障术中玻璃体腔注射曲安奈德的临床观察

Effect of intravitreous injection with triamcinolone acetonide for cataract operation with diabetic macular edema

目的：评价白内障超声乳化吸除及人工晶状体植入术中玻璃体腔内注射曲安奈德（ TA）对伴有糖尿病黄斑水肿的白内障患者的疗效及安全性。方法25例合并糖尿病黄斑水肿的白内障患者随机分为注药组、对照组，均采用标准的超声乳化白内障吸除及人工晶状体植入术。注药组13例患者术毕时，玻璃体腔内注射TA 4 mg／0．1 mL；对照组12例患者未进行玻璃体药物注射治疗。术后随访1～3个月，观察手术前、后（45±10）d的视力、黄斑中心凹视网膜厚度、眼压及并发症。结果所有患者术后视力较术前皆有提高，但仅有注药组视力改善与术前差异有统计学意义（P＜0．05）。注药组术后视力优于对照组，差异有统计学意义（P＜0．05）。术前和术后（45±10）d黄斑中心厚度：注药组术前比术后明显下降，差异有统计学意义（P＜0．05）。注药组术后黄斑厚度明显低于对照组，差异有统计学意义（ P＜0．05）。对照组术后比术前视网膜厚度有所增加，差异无统计学意义（P＞0．05）。2组间眼压差异无统计学意义（P＞0．05）；2组皆未观察到严重术后并发症。结论白内障超声乳化及人工晶体植入术中联合TA玻璃体腔注射术能够明显提高患者视力，减轻黄斑水肿，为后续观察和治疗创造条件。（中国眼耳鼻喉科杂志，2015，15：32-35）

Objective To evaluate the effect of intravitreous injection with triamcinolone acetonide （ TA ） for cataract operation with diabetic macular edema .Methods Twenty-five patients performed cataract operation with diabetic macular edema were divided into two groups .The injection group （ 13 patients ） was performed intravitreous injection with TA,the control group （12 patients ） was not performed intravitreous injection .The visual acuity, retinal thickness of central fovea of macula and intraocular pressure before and after the operation （45 ±10 d） were observed. Results All the patients had better the visual acuity after surgery than before the surgery , however , there was statistically significant difference of visual acuity improvement only in injection group （P〈0.05）.The postoperative visual acuity of the injection group was better than that of the control group , and there was statistically significant difference between the two groups （P〈0.05）.Besides, there was statistically significant difference of central macular thickness between preoperative and （45 ±10） d postoperative （P 〈0.05）.There was no significant difference of intraocular pressure between the two groups （P〉0.05）.Conclusions Intravitreous injection with triamcinolone acetonide for phacoemulsification can significantly improve visual acuity , alleviate macular edema , and provide better prognosis for follow-up and treatment .