巩膜后注射曲安奈德治疗视网膜色素变性黄斑水肿的短期疗效分析

Efficacy of post-sclera injection of triamcinolone acetonide on patients with retinitis pigmentosa accompanied by macula edema

目的观察巩膜后注射曲安奈德（triamcinolone acetonide,TA）在视网膜色素变性（retinitis pigmentosa,RP）黄斑水肿患者治疗中的安全性和临床疗效。方法纳入2013-2014年西南医院眼科门诊确诊为RP黄斑水肿患者10例,其中男性5例,女性5例;年龄（34.9±13.6）岁,均为双眼发病。手术前行视力、眼压、眼底彩色照相、眼底自发荧光（fundus autofluorescence,FAF）、眼底荧光造影（fundus fluorescein angiography,FFA）、光学相干断层扫描（optical coherence tomography,OCT）、闪光视网膜电图（flash electroretinogram,FERG）及多焦视网膜电图（multifocal electroretinogram,mf ERG）等检查。单眼行巩膜后注射TA 20 mg,观察治疗眼术后视力、眼压、黄斑1-9区OCT等变化以及相关并发症情况。结果 10例患者术后1周黄斑中心凹（1区）厚度较术前下降[（298.7±146.2）vs（358.4±152.2）μm,P=0.073],术后1个月1区厚度较术前显著下降[（279.6±130.5）vs（358.4±152.2）μm,P=0.023]。与术前相比,10例患者黄斑1-9区平均厚度在术后1周[（284.3±76.8）vs（301.9±83.3）μm,P=0.047]及术后1个月[（271.9±68.7）vs（301.9±83.3）μm,P=0.011]均明显下降。患者术后1周、1个月视力较术前分别提高2个和6个字母数。无术后高眼压、结膜出血、感染等并发症。结论巩膜后注射TA可用于治疗RP黄斑水肿,未出现并发症,并能有效减轻黄斑水肿。

Objective To observe the safety and clinical efficacy of post-sclera injection of triamcinolone acetonide on patients with retinitis pigmentosa accompanied by macula edema. Methods Ten patients with retinitis pigmentosa accompanied by macula edema were recruited in Southwest hospital ophthalmology clinics in 2013- 2014. The patients were 5 males and 5 females,34. 9 ± 13. 6 years old,and both eyes were diseased. Visual acuity, intraocular pressure, fundus color photography, fundus autofluorescence（ FAF）,fundus fluorescein angiography（ FFA）,optical coherence tomography（ OCT）,flash electroretinogram（ FERG）,and multifocal electroretinogram（ mf ERG） were applied before surgery.Monocular post-sclera injection of triamcinolone acetonide（ 20 mg） was performed. Parameters of visual acuity,intraocular pressure, and OCT changes of macular area were observed after surgery. Related postoperative complications were also recorded. Results The thickness of macular fovea（ 1 zone） of the 10 patients was decreased in postoperative 1 week and 1 month as compared with the preoperative value,and the difference between postoperative 1 month and pre-operation was statistically significant（ 279. 6 ± 130. 5 vs358. 4 ± 152. 2 μm,P = 0. 023）,however,the difference between postoperative 1 week and pre-operation was not significant（ 298. 7 ± 146. 2 vs 358. 4 ± 152. 2 μm,P = 0. 073）. Compared with the preoperative value,the average thickness of macular 1-9 zones was significantly decreased in postoperative 1 week（ 284. 3 ± 76. 8 vs301. 9 ± 83. 3 μm,P = 0. 047） and in postoperative 1 month（ 271. 9 ± 68. 7 μm vs 301. 9 ± 83. 3 μm,P =0. 011）. Visual acuity was improved,and the alphabet numbers were averagely increased by 2 and 6 in postoperative 1 week and 1 month, respectively. Postoperative high intraocular pressure, conjunctival hemorrhage,infection,and other adverse reactions were not seen. Conclusion Post-sclera injection of triamcinolone acetonide can effectively alleviate macular edema caused by retinitis pigmentosa without any complications.