曲安奈德对后发性白内障的预防作用

Exploration of the preventive effect of triamcinolone acetonide on posterior capsular opacification

目的探讨前房内低浓度曲安奈德对后发性白内障（PCO）的预防作用。方法前瞻性临床随机对照研究。随机选取2013年3月至2014年3月在武汉大学中南医院眼科门诊完善相关检查后确诊为年龄相关性白内障患者120例（120只眼）。将患者按照随机数字表法随机分为2组，所有患者均行晶状体超声乳化摘除术，术毕时对照组前房注入0．2ml 0.9％氯化钠，实验组前房注入0．2ml 4mg／100ml曲安奈德（TA）混悬液。术后随访36个月，分别观察比较2组后发障的发生率、术后早期前房炎症反应、眼压及角膜内皮细胞计数等指标。结果最终完成36个月随访并纳入临床分析共112例（112只眼），其中实验组54例（54只眼），对照组58例（58只眼）。术后3、6、12、24、36个月，实验组PCO发生率均较对照组低，差异有统计学意义（χ^2=4．038，7．377，5．255，4．809，4．127，均P〈0．05）。实验组术后第3天前房炎症反应与对照组比较差异有统计学意义（χ^2=9．635，P〈0．05）。术后2组1、2周及1、3、6、12、24、36个月眼压比较，差异无统计学意义（P〉0．05）。术后2组3、6、12、24、36个月角膜内皮计数比较，差异无统计学意义（P〉0．05）。结论白内障手术过程中给予前房注入低浓度曲安奈德可降低PCO的发生率并延缓其发生时间，减少术后早期前房炎症反应，对眼压和角膜内皮无明显影响，是一种安全有效预防PCO的方法。

Objective To investigate the preventive effect of low concentration of triamcinolone acetonide injected in anterior chamber on posterior capsular opacification. Methods A prospective clinical randomized controlled study of 120 patients with age-related cataract which diagnosed in Department of Ophthalmology of Zhongnan Hospital of Wuban University were selected from March 2013 to March 2014. A total of 120 cases （120 eyes） were randomly divided into two groups and performed cataract phacoemulsification. The experimental group was injected triamcinolone acetonide （4 mg/100 ml, 0.2 ml） in anterior chamber after cataract phacoemulsification while the control group was injected sodium chloride （0.9%, 0.2 ml） in anterior chamber after operation. Postoperative follow- up 36 months, the incidence of postoperative posterior capsular opacification, early preoperative inflammatory response, intraocular pressure and comeal endothelial cells count in the two groups were observed. Results All 112 cases （112 eyes） were completed and included in the clinical analysis, in-cluding 54 cases （54 eyes） in experimental group and 58 cases （58 eyes） from control group. In the 3, 6, 12, 24 and 36 months after surgery, the incidence of postoperative posterior capsular opacification in the experimental group was lower than that in the control group （χ^2=4.038, 7.377, 5.255, 4.809, 4.127, P 〈0.05） . Compared to the control group, the early anterior chamber inflammatory response in the experimental group shows statistically significant difference.χ^2=9.635, P 〈0.05）. There were no statistical differences in intraocular pressure and corneal endothelia cells count between the two groups at each time point （all of which were P 〉0.05）. Conclusions Anterior chamber injec- tion of low concentration of triamcinolone acetonide is an effective and safe way which can reduce and prevent the incidence of posterior capsular opacification and delay the onset of posterior capsu- lar opacification after cataract phacoemulsification.