玻璃体内注射曲安奈德联合黄斑部格栅样光凝治疗弥漫性糖尿病性黄斑水肿

Intravitreal triamcinolone acetonide and macular grid photocoagulation for diffuse diabetic macular edema

目的评价玻璃体内注射曲安奈德(triamcinolone acetonide,TA)联合黄斑部格栅样光凝治疗弥漫性糖尿病性黄斑水肿(diabetic macular edema,DME)短期的临床疗效和安全性。方法将35例(39眼)弥漫性DME患者根据治疗方法不同分为2组,分别为单纯TA治疗组(24眼)和联合治疗组(TA注射联合黄斑部格栅样光凝术,15眼)。其中联合治疗组在TA注射1个月后行黄斑部格栅样光凝术,距TA注射术后3个月、6个月分别观察2组患者最佳矫正视力、眼压、裂隙灯显微镜、彩色眼底照相、OCT及并发症情况。结果治疗后3个月,单纯TA治疗组和联合治疗组最佳矫正视力分别为0.16±0.08、0.16±0.17,黄斑中心凹视网膜厚度分别为(272.2±59.4)μm、(279.0±98.9)μm,眼压分别为(15.4±4.3)mm Hg(1 k Pa=7.5 mm Hg)、(14.9±3.2)mm Hg,2组间最佳矫正视力、黄斑中心凹视网膜厚度和眼压比较差异均无统计学意义(均为P>0.05);治疗后6个月,单纯TA治疗组和联合治疗组最佳矫正视力分别为0.27±0.03、0.28±0.15,黄斑中心凹视网膜厚度分别为(289.2±33.9)μm、(248.0±102.7)μm,眼压分别为(15.5±2.3)mm Hg、(15.1±3.5)mm Hg,2组间最佳矫正视力、黄斑中心凹视网膜厚度和眼压比较差异亦均无统计学意义(均为P>0.05)。与治疗前视力相比,两组在治疗后3个月、6个月均有所提高,与治疗前黄斑中心凹视网膜厚度相比,两组均有所下降,与治疗前眼压相比,两组无明显变化。结论与单纯TA注射相比,玻璃体内注射TA联合黄斑部格栅样光凝治疗弥漫性DME短期内疗效和安全性并不占据明显优势。鉴于本次病例观察时间较短,尤其再次治疗的患者例数较少,故其远期疗效、安全性仍有待大样本的长期观察。

Objective To evaluate the efficacy and safety of intravitreal triamcinolone acetonide （TA） injection combined with macular grid photocoagulation for diffuse diabetic macular edema （DME）. Methods Thirty-five cases （39 eyes） with diffuse DME were randomly divided into TA injection group （24 eyes） and combined treatment group （ intravitreal injection of TA combined with macular grid photocoagulation, 15 eyes）. The combined treatment group underwent macular grid section photocoagulation surgery after 1 month of TA injection, the best corrected visual acuity, intraocular pressure （IOP）, slit lamp, color fundus photography, FFA and OCT and complications were observed at 3 months and 6 months after TA injection. Results The best corrected visual acuity at 3 months in TA injection group and combined treatment group were 0.16 ±0.08 and 0.16 ±0. 17 ,respectively;The foveal retinal thickness were （272.2 ±59.4） μm and （279.0 ±98.9） μm, respectively; The intraocuiar pressure were （ 15.4 ±4.3 ） mmHg （ 1 kPa = 7.5 mmHg） and （ 14.9± 3.2 ） mmHg, respectively; The differences in best corrected visual acuity, foveal retinal thickness and intraocuiar pressure was not statistically significant （ all P 〉 0.05 ）. The best corrected visual acuity at 5 months in TA injection group and combined treatment group were 0.27 ±0.03 and 0.28 ±0. 15, respectively;The foveal retinal thickness were （289.2 ±33.9） μm and （248.0 ± 102.7） μm,respectively ;The intraocular pressure were （ 15.5 ± 2.3 ） mmHg （ 15.1 ±3.5 ） mm- Hg, respectively;The differences in best corrected visual acuity, foveal retinal thickness and intraocular pressure was not statistically significant （ all P 〉 0.05 ）. Compared with pre-operation, the visual acuity at 3 months,6 months after treatment in the two groups improved;the foveal retinal thickness were decreased;the intraocular pressure had no obvious change. Conclusion Compared with the simple TA injection, the efficacy and safety of TA combined with macular laser photocoagulation for diffuse DME is not dominant in the short term. In view of this case observation time is shorter, in particular, the number of patients treated with less, so its exact effect, safety of the treatment are still need a large sample for further long-term observation.