甲强龙联合地塞米松交替球周注射治疗脉络膜脱离型视网膜脱离

Alternating peribulbar injection of methylprednisolone and dexamethasone for combined choroidal detachment and retinal detachment

目的评价甲强龙联合地塞米松交替球周注射在玻璃体切割术治疗脉络膜脱离型视网膜脱离中的疗效。方法回顾性分析我科2012年1月至2013年12月收治的临床确诊为脉络膜脱离型视网膜脱离的患者共46例46眼。按糖皮质激素的给药途径,分为静脉组与球周组各23例23眼,均行玻璃体切除+硅油充填术,术后随访12个月以上。对比两组手术前后最佳矫正视力、眼压、术前糖皮质激素使用时间、不良反应发生率、视网膜脱离一次手术复位率、视网膜脱离复发率等。结果静脉组与球周组患者入院时眼压分别为(6.74±2.33)mm Hg(1 k Pa=7.5 mm Hg)和(6.96±1.88)mm Hg,使用糖皮质激素后术前眼压分别为(9.34±1.50)mm Hg和(9.43±1.08)mm Hg;最佳矫正视力入院时分别为2.07±0.14和2.23±0.16,出院时分别为2.02±0.17和2.03±0.14,两组组内比较差异均有统计学意义(均为P<0.05),而组间比较差异均无统计学意义(均为P>0.05)。术后12个月内静脉组与球周组一次性视网膜脱离复位例数分别为19例和21例、视网膜脱离复发例数分别为4例和2例,差异均无统计学意义(均为P>0.05);而两组在术前糖皮质激素使用时间,静脉组为(5.35±0.12)d、球周组为(4.04±0.38)d,差异有统计学意义(t=2.31,P=0.03);糖皮质激素使用不良反应,静脉组为6例、球周组为0例,差异有统计学意义(χ2=6.9,P=0.009)。结论甲强龙联合地塞米松交替球周注射是一种玻璃体切割术治疗脉络膜脱离型视网膜脱离的安全有效的方法。

Objective To evaluate curative effects of alternating peribulbar injec- tion of methylprednisolone and dexamethasone in vitrectomy for choriodal detachment and retinal detachment. Methods Retrospective analysis was performed on 45 cases （46 eyes） of patients who were definitely diagnosed as choriodal detachment and reti- nal detachment, and accepted treatment in our department from January 2012 to Decem- ber 2013. The patients were divided into two groups, namely vein group and peribulbar group according to administration route of glucocorticoid, 23 cases in each group. The vitrectomy and silicone oil filling operation was applied for both groups and follow-up treatment was performed for more than six months. The preoperative and postoperative best corrected visual acuity, intraocular pressure variation, preoperative glucocorticoid applying time, occurrence rate of adverse reaction, one-time surgical reduction rate of retinal detachment, recurrence of retinal detachment were analyzed in the two groups. Results The intraocular pressure in vein group and peribulbar group at being admit- ted to hospital were（6.74 ±2.33）mmHg（ 1 kPa =7.5 mmHg） and（5.96 ± 1.88） mmHg, respectively, the preoperative intraocular pressure after applying glucocorticoid were （ 9. 34 ± 1.50 ） mmHg and （ 9.43 ± 1.08 ） mmHg, respectively; The best corrected visual acuity at being admitted to hospital were 2.07 ± 0. 14 and 2.23 ± 0. 15, respectively, and were 2.02 ± 0.17 and 1.03 ± 0.14 when discharged from the hospital, there were statistical differences between intra-groups（P 〈 0.05 ）, while the difference among groups was