曲安奈德联合改良格栅样光凝治疗糖尿病黄斑水肿临床评价

Clinical Evaluation on Triamcinolone Acetonide Combined with Modified Grid Laser Photocoagulation in the Treatment of Diabetic Macular Edema

目的探讨曲安奈德联合改良格栅样光凝治疗糖尿病黄斑水肿(DME)的疗效,以及对患者眼内压、最佳矫正视力(BCVA)及黄斑中心凹视网膜厚度(CMT)的影响。方法选择医院2015年11月至2017年11月收治的DME患者108例(108眼),按随机数字表法分为观察组和对照组,各54例(54眼)。两组均给予改良格栅样光凝治疗,观察组加用玻璃体腔注射曲安奈德注射液,术后随访3个月。结果各时间点眼压组间和组内比较,差异均无统计学意义(P>0.05);两组患者术后不同时间点组内BCVA改善情况比较,差异有统计学意义(P<0.05);观察组术后2周、1个月、3个月CMT均显著低于对照组(P<0.05);荧光素眼底血管造影(FFA)结果显示,观察组术后1个月总有效率为68.52%,明显高于对照组的37.04%(P<0.05);观察组有3例出现注射部位出血,经止血化瘀治疗后,均完全被吸收;两组均未出现球后出血、白内障、感染性眼内炎等并发症。结论曲安奈德联合改良格栅样光凝治疗DME疗效显著,能减轻黄斑水肿症状,改善视力,且并发症较少。

Objective To investigate the clinical efficacy of triamcinolone acetonide combined with modified grid laser photocoagulation in the treatment of diabetic macular edema(DME)and its effect on intraocular pressure,best corrected visual acuity(BCVA)and central macular thickness(CMT).Methods Totally 108 DME patients(108 eyes)admitted to our hospital from November 2015 to November2017 were selected and divided into the observation group and the control group according to the random number table method,54 cases in each group.The patients in the two groups were given modified grid laser photocoagulation,on this basis,the patients in the observation group were additionally given intravitreal injection of triamcinolone acetonide.All patients were followed up for 3 months after operation.Results There was no significant difference in the intraocular pressure between-group at each time point and within-groups(P>0.05).The differences in the BCVA improvement within-groups at different time points after operation were statistically significant in the two groups(P<0.05).2 weeks,1 month and 3 months after operation,the CMT in the observation group was significantly lower than that in the control group(P<0.05).1 month after operation,the results of fundus fluorescein angiography(FFA)showed that the total effective rate of the observation group was 68.52%,which was significantly higher than 37.04%of the control group(P<0.05).There were 3 cases of injection site bleeding in the observation group,which were completely absorbed after hemostasis and removing blood stasis treatment.There were no complications such as retrobulbar hemorrhage,cataract,infectious endophthalmitis in the two groups.Conclusion Triamcinolone acetonide combined with modified grid laser photocoagulation is effective in the treatment of DME,it can alleviate the symptoms of macular edema and improve the vision,and it has few complications.