玻璃体腔注射曲安奈德对糖尿病性视网膜病变患者超声乳化白内障吸除术后黄斑厚度的影响

Effect of intravitreal triamcinolone acetonide injection on macular thickness in diabetic retinopathy patients having phacoemulsification

目的观察超声乳化白内障吸除联合玻璃体腔注射曲安奈德术对糖尿病性视网膜病变患者术后黄斑厚度的影响。方法收集2012年2月至2014年5月在河南省焦作煤业(集团)有限责任公司中央医院眼科行超声乳化白内障吸除术的48例(48只眼)DR患者的临床资料。按照数字表法随机将患者分为对照组26例(26只眼)和观察组22例(22只眼)。对照组患者常规行超声乳化白内障吸除术,观察组患者在超声乳化白内障吸除术结束时行玻璃体腔注入曲安奈德。手术前、后观察组和对照组患者的最佳矫正视力、黄斑中心凹厚度及眼压情况以均数±标准差(x珋±s)的形式表示,并采用两因素重复测量方差分析的方法进行组间比较;采用配对t检验的方法进行组内比较。结果术前及术后1 d和1、3及6个月对照组患者的最佳矫正视力分别为(0.29±0.09)、(0.65±0.26)、(0.68±0.23)、(0.73±0.21)及(0.72±0.22),观察组分别为(0.31±0.11)、(0.75±0.25)、(0.78±0.20)、(0.79±0.17)及(0.76±0.19)。两组患者的最佳矫正视力比较,差异无统计学意义(F=0.85,P>0.05)。对照组患者术后各时间段的最佳矫正视力与术前比较,差异有统计学意义(t1=6.67,8.05,9.82,9.22;P1<0.05)。观察组患者术后各时间段的最佳矫正视力与术前比较,差异有统计学意义(t2=7.56,9.66,11.12,9.61;P2<0.05)。术前及术后1、3及6个月对照组患者的黄斑中心凹厚度分别为(196.46±17.92)μm、(239.04±17.36)μm、(215.57±21.10)μm及(212.89±28.77)μm,观察组分别为(193.46±20.38)μm、(194.75±16.19)μm、(190.24±17.60)μm及(192.62±21.41)μm。两组患者的黄斑中心凹厚度比较,差异有统计学意义(F=6.82,P<0.05)。对照组患者术后各时间段的黄斑中心凹厚度与术前比较,差异有统计学意义(t1=8.70,3.52,2.47;P1<0.05)。观察组患者术后各时间段的黄斑中心凹厚度与术前比较,差异无统计学意义(t2=0.23,0.56,0.13;P2>0.05)。术前及术后1 d和1、3及6个月对照组患者的眼压分别为(15.40±2.11)mm Hg(1mm Hg=0.133 k Pa)、(15.32±2.21)mm Hg、(15.23±1.93)mm Hg、(16.07±2.04)mm Hg及(15.48±1.89)mm Hg,观察组分别为(14.35±1.81)mm Hg、(16.85±3.37)mm Hg、(15.73±1.82)mm Hg、(15.35±1.95)mm Hg及(15.78±1.73)mm Hg。两组患者的眼压比较,差异无统计学意义(F=1.34,P>0.05)。观察组患者术后各时间段的眼压与术前比较,差异无统计学意义(t1=0.13,0.28,1.16,0.14;P1>0.05)。观察组患者术后各时间段的眼压与术前比较,差异无统计学意义(t2=3.06,2.52,2.01,2.67;P2<0.05)。观察组22例(22只眼)患者中有3例(3只眼)患者术后第1天眼压高于21mm Hg,经噻吗洛尔滴眼液2次/d滴眼,1周内均恢复正常,对照组无眼压升高患者。术后对照组中有4例(4只眼)患者出现有临床意义的黄斑水肿,观察组未出现。结论超声乳化白内障吸除术联合玻璃体腔注射曲安奈德能够阻止DR患者白内障术后黄斑中心凹的增厚,降低黄斑水肿的发生率,对术后视力及眼压无明显影响。

Objective Observe effect of intravitreal triamcinolone acetonide injection on macular thickness in diabetic retinopathy patients having phacoemulsification. Methods 48 cases （48 eyes ） nonproliferation diabetic retinopathy patients with cataract were randomly divided into control group and intravitreal injection group. Treat 26 eyes in control group only with phacoemulsification, and 22 eyes in intravitreal injection group with intravitreal triamcinolone acetonide injection at the end of phacoemulsification. Compare two groups of postoperative visual acuity, central macular thickness, intraocular pressure and the development of macular edema. Results The best corrected visual acuity of control group were （0.65±0.26）, （0.68±0.23）, （0.73±0.21 ）, （0.72±0.22 ）, which of injection group were （0.75±0.25）,（0.78±0.20）, （0.79±0. 17）, （0.76±0. 19） in 1 day and 1,3,6 months after operation. The intraocular pressure of control group were （ 15.32±2.21 ）, （ 15.23±1.93 ） , （ 16.07±2.04 ） , （ 15.48±1.89 ）mmHg, which of injection group were （ 16.85±3.37 ）, （ 15.73±1.82 ）, （ 15.35±1.95 ）, （ 15.78±1.73） mmHg in 1 day and 1,3,6 months after operation. There is no statistically significant difference between the best corrected visual acuity and intraocular pressure of two groups （ P〉0.05 ）. Central macular thickness of control group were （ 239.04±17. 36 ）, （ 215.57±21. 10 ）, （ 212. 89±28.77 ） tzm, which of injection group were（ 194.75±16. 19 ）, （ 190.24±17.60 ）, （ 192.62±21.41 ）μm in 1,3,6 months after operation. Central macular thickness of injection group was less than that of control group in 1,3 and 6 months after operation （P〈0.05）. There were 4 eyes with macular edema in control group and no one in injection group. Conclusion Intravitreal triamcinolone acetonide injection can prevent the increase of central macular thickness and reduce the occurrence of macular edema in diabetic retinopathy patients having phacoemulsification,which had no obvious effect on postoperative visual acuity and intraocular pressure.