不同剂量的曲安奈德玻璃体腔注射联合光凝治疗视网膜分支静脉阻塞合并黄斑水肿的疗效观察

Clinical observation of intravitreous injection of different doses of triamcinolone acetonide combined with laser coagulation for macular edema complicated with branch retinal vein occlusion

目的比较不同剂量的曲安奈德(TA)行玻璃体腔注射联合光凝治疗视网膜分支静脉阻塞(BRVO)合并黄斑水肿的疗效。方法本研究纳入缺血型BRVO患者78例78眼,病程均<3月,将所有患者随机分为2组,A组40例(40眼),行玻璃体腔注射TA 2 mg,B组38例(38眼)行玻璃体腔注射TA 4 mg,2组患者均于2周后行视网膜局部光凝及黄斑区格栅样光凝治疗。分析比较2组治疗前后眼前节、最佳矫正视力(BCVA)、光学相干断层扫描(OCT)的改变。结果 A组、B组治疗前后BCVA及黄斑中心凹厚度(CMT)均较治疗前明显改善(P均<0.05)。A组与B组间治疗后BCVA及CMT差异无统计学意义(P>0.05)。A组、B组治疗前眼压比较无统计学差异(P>0.05)。治疗后2周A组眼压与治疗前比较差异无统计学意义(P>0.05),B组眼压与治疗前比较明显升高(P<0.05);治疗后2周,B组眼压较A组显著升高(P<0.05)。治疗后1,3,6月B组眼压与A组比较差异无统计学意义(P>0.05)。结论不同剂量的TA玻璃体腔注射联合光凝治疗BRVO合并黄斑水肿均可起到持久的疗效,小剂量的TA玻璃体腔注射明显减少TA所引起的并发症,效果更佳。

Objective To study the clinical effects of intravitreous injection of different doses of triamcinolone acetonide（ TA） combined with laser coagulation for macular edema associate with branch retinal vein occlusion（ BRVO）.Methods Seventy-eight patients with BRVO（ 78 eyes） were enrolled in this research,and divided into group A and group B. The disease courses of all patients were less than three months. Forty cases（ 40 eyes） in group A received intravitreous injection of TA 2 mg,and 38 cases（ 38 eyes） in group B received intravitreous injection of TA 4 mg. Then all the patients underwent macular and local area laser after two weeks. Before and after treatment,anterior segment,best corrected visual acuity（ BCVA）,optical coherence tomography（ OCT） were detected and compared between two groups.Results BCVA and central macular thickness（ CMT） in group A and group B were obviously improved after treatment（ P0. 05）. BCVA and CMT after treatment showed no significant differences between group A and group B（ P0. 05）.Intraocular pressure before treatment showed no significant difference between group A and group B（ P0. 05）. Compared with before treatment,intraocular pressure two weeks after treatment showed no statistical differences in group A（ P0. 05）,while showed statistical difference in group B（ P 0. 05）. 1,3,6 months after treatment,the level of intraocular pressure showed no statistical differences between two groups（ P 0. 05）. Conclusions Intravitreous injection of low dose of triamcinolone acetonide combined with laser coagulation for macular edema complicated with branch retinal vein occlusion can acquire lasting curative effect,with less complications.