曲安奈德球周注射联合全视网膜光凝对重度非增殖性糖尿病性视网膜病变的疗效观察

Effect of Combined Treatment of Peribulbar Injection of Triamcinolone Acetonide and Panretinal Photocoagulation on Severe Nonproliferative Diabetic Retinopathy

目的探讨曲安奈德球周注射联合全视网膜光凝对重度非增殖性糖尿病性视网膜病变(nonproliferative diabetic retinopathy,NPDR)患者黄斑厚度及视功能的影响。方法重度NPDR患者40例40只眼,根据光学相干断层扫描(optical coherence tomography,OCT)检查结果分为两大组:重度NPDR伴有临床意义黄斑水肿组(clinical significant macular edema,CSME)患者20只眼和重度NPDR不伴有黄斑水肿组(nonmacular edema,NE)患者20只眼。两大组组内又随机分为联合组和对照组两个小组,(1)CSME组:联合组10只眼,采用曲安奈德球周注射联合全视网膜光凝;对照组10只眼,仅接受全视网膜光凝。(2)NE组:联合组10只眼,患者均于全视网膜光凝开始前1周及全视网膜光凝结束时进行曲安奈德20 mg球周注射;对照组10只眼,仅接受全视网膜光凝。所有患者均于治疗开始前以及治疗后1、3和6个月接受眼压、最佳矫正视力、OCT和微视野计(microperimetry-1,MP-1)的检查。结果 (1)NE组:联合组的最佳矫正视力、黄斑厚度和黄斑区光敏度较治疗前均无明显变化(P>0.05),对照组的最佳矫正视力、黄斑区光敏度较治疗前均有不同程度的下降(P<0.05),黄斑厚度较治疗前有增加(P<0.05)。(2)CSME组:联合组的黄斑厚度较治疗前有下降(P<0.05),最佳矫正视力、黄斑区光敏度较治疗前无明显变化(P>0.05),对照组的黄斑厚度较治疗前明显增加(P<0.05),最佳矫正视力较治疗前明显下降(P<0.05),黄斑区光敏度较治疗前无明显变化(P>0.05)。结论曲安奈德球周注射能够有效预防全视网膜光凝造成的视力下降及黄斑增厚,改善其对黄斑区光敏度的损伤。

Objective To investigate the effect of the combined treatment of peribulbar injection of triamcinolone acetonide and panretinal photocoagulation on the macular thickness and visual function of patients with severe nonproliferative diabetic retinopathy（ NPDR）.Methods Altogether 40 patients（ 40 eyes） with severe nonproliferative diabetic retinopathy were divided into two groups by results of optical coherence tomography（ OCT） ： one had 20 patients（ 20 eyes） with significant macular edema,and the other consisted of 20patients（ 20 eyes） without macular edema. The group with clinical significant macular edema was randomly spit into an experimental group（ 10 eyes） and a control group（ 10 eyes）. The patients in the experimental group were given the combined treatment of peribulbar injection of triamcinolone acetonide and panretinal photocoagulation while the patients in the control group receiving panretinal photocoagulation only. These steps were repeated for the group without macular edema. The patients in the experimental group were given peribulbar injection of triamcinolone acetonide（ 20 mg） a week before the first photocoagulation as well as after the fourth photocoagulation. Intraocluar pressure,best corrected visual acuity,OCT and MP-1 microperimetry were measured before the treatment and one month,three months and six months after the treatment respectively.Results As to the group without macular edema,the best corrected visual acuity,macular thickness and macular sensitivity in the experimental group did not change significantly after the operation in the experimental group（ P 〉0. 05）,but the best corrected visual acuity and macular sensitivity decreased significantly（ P 〈0. 05） and macular thickness increased significantly（ P〈 0. 05） in the control group. For the group with clinical significant macular edema,no significant change（ P〉 0. 05） occurred to the best corrected visual acuity and macular sensitivity and the macular thickness decreased significantly（ P 〈0. 05） in the experimental group; on the other hand,the macular sensitivity did not change significantly（ P 〉0. 05） after the operation while the macular thickness increased significantly（ P 〈0. 05） and the best corrected visual acuity decreased significantly（ P 〈0. 05） in the control group.Conclusions For severe nonproliferative diabetic retinopathy,the treatment of peribulbar injection of triamcinolone acetonide prevents effectively the damage of panretinal photocoagulation on macular thickness and visual function.