玻璃体切除联合曲安奈德玻璃体注射治疗增殖期糖尿病视网膜病变

Effect of vitrectomy with intravitreal injection of triamcinolone acetonide in the treatment of proliferative diabetic retinopathy

目的:观察玻璃体切除联合曲安奈德玻璃体腔注射治疗增殖期糖尿病视网膜病变的疗效。方法:对45例47眼增殖期糖尿病视网膜病变行玻璃体切除联合曲安奈德注射液2mg玻璃体腔注射治疗,观察术中术后并发症情况以及术后视力、眼压、黄斑中心凹厚度变化情况。结果:术中并发症:有7眼(15%)发生医源性裂孔,有13眼(28%)发生视网膜出血;术后并发症:13眼(28%)发现曲安奈德进入前房,有9眼(19%)前房积血,有6眼(13%)发生眼底出血;术后视力:术后3mo有35眼(74%)视力较术前提高(P<0.05),术后6mo有27眼(57%)视力较术前明显提高(P<0.05);术后眼压:术后第7d,1、3、6mo时眼压分别为23.47±5.21、26.58±6.35、19.12±5.76、17.43±4.91mmH g,与术前眼压16.32±4.64mmH g比较、术后第7d,1mo差异有统计学意义(P<0.05),术后3、6mo差异无统计学意义(P>0.05);术后第7d,1、3、6mo时黄斑中央凹厚度分别是404.05±89.71、277.14±41.25、254.82±33.64、226.49±28.57μm,与术前黄斑中央凹厚度433.51±101.02μm比较,术后第7d时差异无统计学意义(P>0.05),术后1、3、6mo时差异有统计学意义(P<0.05)。结论:玻璃体切割联合曲安奈德2mg玻璃体腔内注射能减轻黄斑水肿,改善视功能,是治疗增生型糖尿病视网膜病变的有效方法。

AIM：To study the effect of vitrectomy with intravitreal injection of triamcinolone acetonide for the treatment of proliferative diabetic retinopathy. METHODS： Vitrectomy with intravitreal injection of triamcinolone acetonide 2mg was performed on 47 eyes of 45 patients. The intraoperative and postoperative complications, postoperative visual acuity, intraocular pressure and the changes of macula central fovea thickness were observed. RESULTS： Intraoperative complications： 7 eyes （ 15%） happened Iatrogenic tear hole, 13 eyes （ 28%） happened retinal hemorrhage;Postoperative complications：13 eyes （ 28%） found triamcinolone acetonide entered anterior chamber, 9 eyes （ 19%） found hyphema, 6 eyes （ 13%） presented fundus hemorrhage. Visual acuity was improved in 35 eyes （74%） after 3mo and 27 eyes （57%） after 6mo, with statistical difference with preoperative （P〈0. 05 ）. the intraocular pressure of postoperative were 23.47±5. 21, 26. 58±6. 35, 19. 12±5. 76 and 17. 43±4. 91mmHg at 7d, 1, 3 and 6mo respectively. Compared with preoperative（16. 32±4. 64mmHg）, the differences had statistically significant at 7d and 1mo （P〈0. 05）. Macula central fovea thickness were 404. 05±89. 71, 277. 14±41. 25, 254. 82±33. 64 and 226.49±28. 57μm at7d, 1, 3 and 6mo respectively. The differences had statistically significant at 1, 3 and 6mo compared with preoperative 433. 51 ±101.02μm （P〈0. 05）. CONCLUSION： Vitrectomy combined with intravitreal injection of triamcinolone acetonide 2mg can reduce macular edema and improve visual acuity. It is an effective and safe procedure for proliferative diabetic retinopathy.