曲安奈德玻璃体腔注射联合格栅样光凝治疗囊样黄斑水肿

Intravitreal triamcinolone acetonide combined with grid laser photocoagulation for patients with cystoid macular edema

目的探讨曲安奈德玻璃体腔注射联合格栅样光凝治疗囊样黄斑水肿的有效性。方法本研究采用前瞻性非随机临床试验比较,对确诊为囊样黄斑水肿的患者14例14眼,经玻璃体腔注射曲安奈德2 mg并行格栅样光凝治疗。对照组为资料齐全并随访时间>6个月的既往病例16例(16眼)。治疗后3、6个月观察最佳矫正视力、眼压、黄斑中心凹视网膜厚度。结果与治疗前视力相比,两组在治疗后3、6个月视力均有提高,差异均有统计学意义(F对照组=11.4,F试验组=16.3,P<0.01),试验组治疗前及治疗后3、6个月与对照组相应时间视力比较差异均无统计学意义(t治疗前=0.122,t治疗3月=1.11,t治疗6月=0.79,P≥0.05)。与治疗前黄斑中心凹视网膜厚度相比,两组黄斑中心凹视网膜厚度均有所下降(F对照组=5.77,F试验组=7.29,P<0.01),试验组治疗前CM T与对照组相应时间CM T比较差异无统计学意义(t治疗前=0.288,P>0.05),试验组治疗后3、6个月CM T与对照组相应时间CM T比较差异有统计学意义(t治疗3月=1.702,t治疗6月=1.92,P<0.05)。试验组术后4眼(28%)眼压升高。结论曲安奈德玻璃体腔注射联合格栅样光凝治疗能有效降低黄斑中心凹视网膜厚度,但必须警惕高眼压及青光眼的发生。

Objective To determine if primary intravitreal injection of triamcinolone acetonide （TA）in combination with grid laser photocoagulation （GLP）is effective in treating cystoid macular edema.Methods A prospective com-parative non-randomized clinical trial was carried out.Fourteen eyes （14 patients）diagnosed with cystoid macular ede-ma were treated with GLP and an intravitreal injection of 2mg TA.A matched control group （16 eyes ,16 patients） treated with GLP was selected retrospectively from our medical records.Best- corrected visual acuity （BCVA）,in-traocular pressure and quantitative changes in optical coherence tomography （OCT）macular thickness were assessed. Results Compared with the pre-treatment,BCVA was significantly elevated in the two groups on 3 and 6 months post-treatment（P〈0.01 ）.No obvious improvement of visual acuity was found between the two groups after treatment at any time point （P≥0.05 ）.Macular thickness was significantly decreased after the treatment in the two groups（P〈0.01）.No significant changes in macular thickness were found between the two groups before the treatment （P〉0.05）,but macular thickness was lower in the trial group compared with the control group at various time point（P〈0.05）.IOP raised in 4 eyes（28%）in the trial group.Conclusion Treatment with IVTA injections in combination with grid laser photocoagulation seems to be more effective in decreasing central subfoveal thickness in patients with cystoid macular edema. However,higher intraocular pressure and development of glaucoma must be considered serious-ly in patients who receive IVTA injection.