后Tenon囊下注射曲安奈德与静脉滴注地塞米松联合玻璃体切除治疗RD/CD

Clinical effect of RD/CD treatment by posterior subcapsular Tenon injection triamcinolone acetonide and intravenous drip of dexamethasone combined vitrectomy

目的:比较后Tenon囊下注射曲安奈德与静脉滴注地塞米松联合玻璃体切除手术治疗脉络膜脱离型视网膜脱离(RD/CD)的临床效果。方法:回顾性选取2014-03/2017-10于我院眼科确诊为RD/CD并采取玻璃体切除手术治疗的病例52例52眼,根据术前的干预治疗方式分为:A组(27例27眼)术前3～5d行每天1次的静脉滴注地塞米松治疗,B组(25例25眼)术前5d行后Tenon囊下注射曲安奈德治疗。检测两组干预前后术眼的眼压、CD情况,术后1、3mo及末次随访的视网膜复位、视力及并发症情况。结果:干预后,B组术眼眼压8.09±3.56mmHg,明显高于本组干预前5.65±2.19mmHg和A组干预后6.25±2.53mmHg(P<0.05); A、 B组患者术眼的CD高度3.98(1.01, 5.34)、0.92(0.03, 3.88)mm,明显低于干预前5.22(3.14, 6.64)、5.16(3.34, 7.71)mm;CD位点6.0(3.0, 10.0)、3.0(0.0, 6.0)个,明显低于干预前11.0(9.0, 12.0)、10.0(8.0, 12.0)个,其中B组术眼的CD高度和CD位点数均低于A组(P<0.05)。术后至末次随访,A、B组的术眼视网膜成功复位率分别为78%和96%(P>0.05)。术后1、3mo和末次随访,A组的术眼视力为1.69±0.79、1.39±0.72、1.38±0.61均优于干预前的2.06±0.28,B组的术眼视力为1.42±0.66、1.29±0.56、0.97±0.51均优于干预前的2.02±0.58,其中B组术后末次随访术眼视力均优于A组(P<0.05)。术后1、3mo,A组均有4眼高眼压,明显少于B组的11、12眼(P<0.05);至末次随访,A组仍有1眼高眼压,B组有2眼(P>0.05)。结论:RD/CD治疗中,后Tenon囊下注射曲安奈德联合玻璃体切除手术治疗的效果明显好于静脉滴注地塞米松联合玻璃体切除手术治疗,但需作好术后眼压监测,如出现眼压偏高需及时处理。

AIM: To compare the clinical effects of retinal detachment with choroidal detachment (RD/CD) treatment by posterior subcapsular Tenon injection triamcinolone acetonide and intravenous drip of dexamethasone combined vitrectomy. METHODS: Totally 52 cases (52 eyes) of RD/CD patients in our hospital from March 2014 to October 2017 were retrospectively reviewed. According to the preoperative intervention methods, the patients were divided into two groups: A group and B group. Group A (27 cases, 27 eyes) received intravenous drip of dexamethasone once a day 3-5d before operation. Group B (25 cases, 25 eyes) received posterior subcapsular Tenon injection triamcinolone acetonide 5d before operation. The intraocular pressure, CD, retinal reattachment, visual acuity and complications were measured before and after the intervention. RESULTS: After intervention, the intraocular pressure of group B was 8.09+3.56mmHg, which was significantly higher than 5.65+2.19mmHg before intervention in group B and 6.25+2.53mmHg after intervention in group A. The difference was statistically significant ( P <0.05). After intervention, the CD height of group A and B was 3.98 (1.01, 5.34) mm and 0.92 (0.03, 3.88) mm, significantly lower than that in group A and B before intervention, which was 5.22 (3.14, 6.64) mm and 5.16 (3.34, 7.71) mm. CD loci 6.0 (3.0, 10.0) and 3.0 (0.0, 6.0) were significantly lower than those of 11.0 (9.0, 12.0) and 10.0 (8.0, 12.0) before intervention. The CD height and the number of CD loci in group B were lower than those in group A ( P <0.05). From the last follow-up, the success rate of retinal reattachment in groups A and B were 78% and 96%, respectively( P >0.05). At 1, 3mo and the last follow-up, the visual acuity of group A was 1.69±0.79, 1.39±0.72 and 1.38±0.61 better than that of group A before intervention 2.06±0.28. The visual acuity of group B was 1.42±0.66, 1.29± 0.56 and 0.97±0.51 better than that of group A before intervention 2.02±0.58. The visual acuity of group B was better than that of group A at the last follow-up, with statistical difference ( P <0.05). At 1 and 3mo after operation, 4 eyes in group A had high intraocular pressure, which was significantly lower than that of 11 eyes and 12 eyes in group B ( P <0.05). At the last follow-up, there was still 1 eye with high intraocular pressure in group A and 2 eyes in group B( P >0.05). CONCLUSION: In the treatment of RD/CD, the effect of posterior subcapsular Tenon injection triamcinolone acetonide with vitrectomy is better than that of intravenous drip of dexamethasone combined vitrectomy, the intraocular pressure should be monitored after operation. If high intraocular pressure occurs, appropriate drug control or removal of triamcinolone acetonide from the posterior Tenon capsule is required.