23G微创玻璃体切除联合曲安奈德治疗增生性糖尿病视网膜病变的临床疗效

Clinical effects of 23- gauge micro- invasive vitrectomy combined with triamcinolone acetonide on the treatment for proliferative diabetic retinopathy

目的探讨23G微创玻璃体切除联合球内及后Tenon囊下应用曲安奈德治疗增生性糖尿病视网膜病变的有效性和安全性。方法回顾性分析研究。对徐州医学院附属淮安医院眼科自2014年6月至2016年6月收治增生性糖尿病患者46例48只眼，行标准三切口玻璃体切除术，术中球内注入曲安奈德8 mg行玻璃体染色并切割吸出，术毕后Tenon囊下注射曲安奈德30 mg，观察术后矫正视力及眼压情况，黄斑中心凹厚度变化及术中术后并发症情况。结果术后视力：术后3个月有36只眼（75%）视力较术前提高（P〈0.05），术后6个月有28只眼（58.33%）视力较术前提高（P〈0.05），差异有统计学意义。术后眼压：术后第7 d、1、3、6个月时眼压分别为（23.48±5.19），（19.02±5.63），（18.58±5.35），（17.42±4.81）mmHg，与术前眼压（16.31±4.63）mmHg比较，术后第7 d差异有统计学意义（P〈0.05），术后1、3、6个月差异无统计学意义（P〉0.05）。术后第7 d、1、3、6个月时黄斑中央凹厚度分别是（296.05±51.71），（277.15±41.24），（254.83±33.62），（226.47±28.56）μm，与术前黄斑中央凹厚度（433.52±101.03）μm比较，差异均有统计学意义（P〈0.05）。术中术后并发症：术中有5只眼（10.42%）发生医源性裂孔，11只眼（22.92%）发生视网膜出血。术后有8只眼（16.67%）前房积血，有7只眼（14.58%）发生眼底出血。结论23G微创玻璃体切除联合曲安奈德术中玻璃体染色及术毕后Tenon囊下注射治疗增生性糖尿病视网膜病变有效安全，能减轻黄斑水肿，改善视功能。

ObjectiveTo study the safety and efficacy of 23-gauge micro-invasive vitrectomy combined with posterior sub-Tenoncapsule injection of triamcinolone acetonide （PSTA） in treating proliferative diabetic retinopathy （PDR）.MethodsThe clinical data of 46 patients with PDR （48 eyes） from June 2014 to June 2016 in Department of Ophthalmology, Huaian Hospital of Xuzhou Medical College were retrospectively analyzed. Pars plana vitrectomy combined with triamcinolone acetonide （TA） was performed on 48 eyes suffered from proliferative diabetic retinopathy and 8 mg of TA was injected into the eyes for dying of vitreous during the operations and 30mg of TA was injected in the posterior sub-Tenon capsule. Postoperatively, the best corrected visual acuity （BCVA）, intraocular pressure （IOP）, changes of macular central fovea thickness, intraoperative and postoperative complications were observed.ResultsThe BCVA was improved in 36 eyes （75%） after 3mo and 28 eyes （58.33%） after 6mo, there was statistical difference with preoperative （P 〈0.05）. The intraocular pressure of postoperative were 23.48±5.19, 19.02±5.63, 18.58±5.35, and 17.42±4.81mmHg at 7d, 1, 3 and 6mo respectively. Compared with preoperative （16.31±4.63mmHg）, the differences had statistically significant at 7d （P 〈0.05）. There was no statistically significant difference at 1, 3 and 6mo （P 〉0.05）. Macula central fovea thickness was 296.05±51.71, 277.15±41.24, 254.83±33.62, and 226.47±28.56um at 7d, 1, 3 and 6mo respectively. The differences had statistically significant at 7d, 1, 3 and 6mo compared with preoperative 433.52±101.03um （P 〈0.05）. Intraoperative complications： 5 eyes （10.42%） happened latrogenic tear hole, 11 eyes （22.92%8%） happened retinal hemorrhage; Postoperative complications： 8 eyes （16.67%） found hyphema, 7 eyes （14.58%） presented fundus hemorrhage.Conclusions23-gauge micro-invasive vitrectomy combined with posterior sub-Tenon capsule injection of triamcinolone acetonide in treating proliferative diabetic retinopathy is safe and effective, and the patients can reduce macular edema and improve visual acuity.