眼内手术中透明质酸钠凝胶与曲安奈德混合物的应用研究

Application of the mixture of sodium hyaluronate gel and triamcinolone acetonide in intraocular surgery

目的观察复杂玻璃体视网膜病变手术中应用透明质酸钠凝胶与曲安奈德混合物的效果。方法前瞻性研究。收集郑州大学第一附属医院2018年5~10月行复杂玻璃体视网膜手术联合硅油填充术者共77例(80只眼),随机分为两组。治疗组,35例(36只眼),手术结束时将1∶1均匀混合的透明质酸钠凝胶与曲安奈德(2 mg)的混合物0.1 ml注入玻璃体腔;对照组,42例(44只眼),手术结束时玻璃体腔内注入曲安奈德(2 mg)。结果治疗组混合物在硅油眼内分布均匀呈弥散样,而对照组单纯的曲安奈德在硅油眼内分布集中呈团块状。治疗组的曲安奈德在眼内2周完全吸收,而对照组的曲安奈德在眼内存留的时间为4~8周;治疗组与对照组的术后早期视力(BCVA)提高率分别为88.89%和43.18%(χ2=19.067,P=0.000);两组术后高眼压的发生率分别为30.56%(11/36)和29.55%(13/44)(χ2=0.010,P=0.557);两组术后前房渗出的发生率分别为22.22%(8/36)和15.91%(7/44)(χ2=0.518,P=0.472);两组增生性玻璃体视网膜病变的发生率分别为38.89%(14/36)和38.64%(17/44)(χ2=0.001,P=0.581)。结论透明质酸钠凝胶与曲安奈德混合物在硅油眼内的分布较均匀,吸收较快;更有利于患者术后早期的视力恢复及眼底观察。

Objective To observe the efficacy of application of the mixture of sodium hyaluronate gel and triamcinolone acetonide(TA)in complex vitreoretinal surgery.Methods Prospective study.Total of 80 eyes of 77 patients who underwent complex vitreoretinal surgery combined with silicone oil tamponade in the First Affiliated Hospital of Zhengzhou University from May to Oct.2018 were collected.All cases were randomly divided into treatment group and control group.At the end of surgery,the 1∶1 mixture 0.1 ml of sodium hyaluronate gel and TA(2 mg)was injected into the vitreous cavity in the treatment group;while the control group received injection of 2 mg TA into the vitreous cavity.Results The distribution of mixture was more uniform and diffuse in the silicone oil eye of treatment group,while the distribution of TA in control group was more concentrated in lumps in the silicone oil eye.The particles of TA could be completely absorbed within 2 weeks in the treatment group,while in control group TA retained for 4-8 weeks.The early postoperative BCVA improvement rate was 88.89%in the treatment group and 43.18%in control group,respectively.The difference of BCVA improvement rate was statistically significant between the two groups(χ2=19.067,P=0.000).The incidence of intraocular hypertension was 30.56%(11/36)in the treatment group and 29.55%(13/44)in control group,respectively(χ2=0.010,P=0.557).The incidence of anterior chamber fibrin exudation in the two groups was 22.22%(8/36)and 15.91%(7/44),respectively(χ2=0.518,P=0.472).The incidence of proliferative vitreoretinopathy(PVR)in the two groups was 38.89%(14/36)and 38.64%(17/44),respectively(χ2=0.001,P=0.581).Conclusion The mixture of sodium hyaluronate gel and TA is more evenly distributed and absorbed faster in the silicone oil tamponade eye.It is more conducive to the early postoperative visual recovery and fundus observation.