增生型糖尿病性视网膜病变术前玻璃体内注射曲安奈德的价值

Application of intravitreal injection of triamcinolone acetonide before vitrectomy for PDR

目的探讨术前玻璃体内注射曲安奈德(triamcinolone acetonide,TA)对于增生型糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)行玻璃体视网膜手术效果的影响。方法选择我院2014年3月至2015年6月收治的PDR患者(Ⅴ期或Ⅵ期)60例(60眼)。随机分为治疗组(术前1周行玻璃体内注射TA)和对照组(直接行玻璃体切割术),每组30例。比较两组患者术中出血情况、医源性视网膜裂孔发生率、眼内填充物的使用、平均手术时间及术后视力。结果治疗组术中发生中、重度出血率为16.7%,显著低于对照组的36.7%,差异有统计学意义(P<0.05);治疗组术中医源性视网膜裂孔发生率为10.0%,显著低于对照组的33.3%,差异有统计学意义(P<0.05);治疗组硅油填充率为40.0%,对照组为60.0%,差异无统计学意义(P>0.05);治疗组手术时间为(40.23±13.90)min,明显短于对照组的(55.82±14.43)min,差异有统计学意义(P<0.05);治疗组术后视力为0.316±0.101,优于对照组的0.202±0.132,差异有统计学意义(P<0.05)。结论 PDR患者在玻璃体切割术前1周行玻璃体内注射TA,可降低手术难度,减少术中并发症,进而缩短手术时间,有助于术后视力改善。

Objective To explore the effects of intravitreal injection of triamcinolone acetonide（ TA） on vitrectomy for proliferative diabetic retinopathy（ PDR）. Methods Sixty eyes of 60 PDR patients（ Ⅴor Ⅵ stage） in our hospital from March 2014 to June 2015 were chosen. The patients were randomly divided into control group（ only receiving vitrectomy）and treatment group（ intravitreal injecting TA one week before vitrectomy）,30 cases in each group. The intraoperative hemorrhage,incidence of iatrogenic retinal hole,use of intraocular implants,average operation time and average postoperative visual acuity of two groups patients were compared. Results The rate of moderate or severe hemorrhage during operation in the treatment group was 16. 7 %,and the control group was 36. 7 %,there was statistical difference between two groups（ P 0. 05）. The incidence rate of iatrogenic retinal hole in the treatment group was 10. 0 %,and the control group was 33. 3 %,there was statistical difference between two groups（ P 0. 05）. The filling rate of silicon oil in the treatment group was 40. 0 %,and in the control group was 60. 0 %,there was no statistical difference betweentwo groups（ P 0. 05）. The operation time of the treatment group was（ 40. 23 ± 13. 90） minutes,and the control group was（ 55.82 ± 14. 43） minutes,there was statistical difference between two groups（ P 〈0. 05）. The post-operative visual acuity of the treatment group was 0. 316 ± 0. 101,and the control group was 0. 202 ± 0. 132,there was statistical difference between two groups（ P〈 0. 05）. Conclusion Intravitreal injecting TA at 1 week before vitrectomy for PDR can decrease the operation difficulty,reduce the intraoperative complications,and shorten the operation time. It is helpful to improve the postoperative visual acuity.