非甾体类抗炎药辅助玻璃体腔内注射曲安奈德治疗黄斑水肿

Non-steroidal anti-inflammatory drug in adjuvant treatment of intravitreal triamcinolone acetonide for macular edema

目的：观察非甾体类抗炎药在玻璃体腔内注射曲安奈德（IVTA）治疗视网膜静脉阻塞（retinal vein occlusion,RVO）引起黄斑水肿的临床价值。方法：选取2012-01/2015-10本院眼科48例48眼RVO并发黄斑水肿且接受IVTA的患者,随机分为两组,每组24眼。试验组在术前1d开始至术后1mo内额外点用普拉洛芬滴眼液。采用光学相干断层扫描仪定量测定黄斑中心凹厚度（central foveal thickness,CFT）。对比两组患者在术前、术后3d,1、2wk,1、3mo时的最佳矫正视力（best corrected visual acuity,BCVA）、CFT、眼压变化及并发症。结果：玻璃体腔注药后,两组患者BCVA较术前有不同程度提高;但在不同时间点,两组患者视力提高行数相比,差异无统计学意义（P〉0.05）。试验组和对照组注射前的CFT分别为629±43μm和605±57μm,差异无统计学意义（P〉0.05）,随访1mo时则分别为432±74μm和511±32μm,差异有统计学意义（t=7.533,P〈0.05）,3mo时分别为275±54μm和379±29μm,差异有统计学意义（t=13.212,P〈0.05）。试验组有5眼IVTA后出现高眼压,经局部药物治疗后眼压稳定,对照组有8眼IVTA后出现高眼压,7眼经局部药物治疗后眼压稳定,1眼接受滤过手术。35眼有晶状体眼中,试验组有3眼出现了白内障进展,4~12mo后有2眼完成白内障手术;对照组有4眼出现了白内障进展,4~12mo后有2眼完成白内障手术。随访期所有患眼注射后均未出现眼内炎和视网膜脱离。结论：围手术期局部使用非甾体类抗炎药物点眼可有助于治疗黄斑水肿,进一步减轻CFT,但需要进一步评估。

AIM ： To study the clinical value of non-steroidal antiinflammatory drug in adjuvant treatment of intravitreal triamcinolone acetonide（ IVTA） for macular edema caused by retinal vein occlusion（ RVO）. METHODS： Forty-eight eyes in 48 patients were randomly divided into trial and control group（ 24 eyes each） in this prospective study. In the trial group,additional pranoprofen drops was administered from1d before IVTA to 30 d after injection. Central foveal thickness（ CFT） was measured with optical coherence tomography（ OCT）. Available documents of best corrected visual acuity（ BCVA）, CFT, intraocular pressure and complications pre-and post-injection at3 d,1,2wk,1 and 3mo were evaluated. RESULTS： After IVTA,BCVA was improved in both groups at different levels; but there was no statistically significant between two groups at each time point（ P 0. 05）. The CFT values were 629 ± 43μ mvs 605 ± 57μ mbefore IVTA in the trail vs control groups（ P0. 05）. The values were 432±74μ mvs 511±32μ m（ t = 7. 533,P0. 05）,and 275±54μ mvs 379±29μ m（ t = 13. 212,P0. 05） of the trial vs control groups at 1 and 3mo after IVTA,respectively. Ocular hypertension occurred in 5 eyes after injection in trail group,and was controlled with anti-glaucoma medication and one eye with filtration surgery.Progression of cataract was noted in 3 of 35 phakic eyes and cataract surgery was performed in 2 eyes at 4-12 mo after injection in trail group. Progression of cataract was noted in 4 eyes and cataract surgery was performed in 2eyes at 4-12 mo after injection in control group. No retinal detachment and endophthalmitis happened during the whole period of follow-up. CONCLUSION： Application of non-steroidal anti-inflammatory eye drops in perioperative period can be useful to improve the outcome of IVTA for macular edema,which needs further evaluation.