曲安奈德玻璃体腔注射治疗黄斑水肿的疗效及并发症分析

Efficacy and complications of intravitreal injection of triamcinolone acetonide for macular edema

背景 曲安奈德可有效治疗各种类型的黄斑水肿,由于手术操作和制备工艺原因,可能引起各种并发症。目的 分析玻璃体腔内注射曲安奈德治疗黄斑水肿的疗效及相关并发症产生的原因。方法 选取2017年1月-2020年6月因黄斑水肿在我中心行玻璃体腔曲安奈德注药的患者。玻璃体腔内注射曲安奈德4 mg/0.1 mL,术后1 d、1个月、3个月、6个月评估视力及并发症情况。结果 189例患者(男104例、女85例) 189眼纳入分析,患者年龄45~82岁,平均年龄(53.3±9.6)岁。黄斑水肿病因:视网膜静脉阻塞97例(51.3%),糖尿病视网膜病变62例(32.8%),视盘血管炎(Ⅱ型) 20例(10.6%),白内障术后10例(5.3%)。术后随访6个月,患者黄斑水肿消退,注药术后最佳矫正视力均有不同程度提高[Md(IQR):0.2(0.1~0.4) vs 0.5(0.25~0.6),P<0.01]。相关性分析结果显示,术后视力与术前视力有较高的相关性(r=0.655,P<0.01)。进一步分析四组不同病因导致的黄斑水肿患者对注药术的反应情况,统计结果显示注药术后各组视力均提高,四组差值比较差异无统计学意义(P>0.05)。术后主要并发症:高眼压42例(22.2%),白内障46例(24.3%),结膜下出血21例(6.3%),角膜上皮剥脱7例(2.1%),非感染性眼内炎5例(1.5%),感染性眼内炎1例(0.3%)。结论 玻璃体腔内注射曲安奈德可有效治疗黄斑水肿,改善视功能;但仍存在发生严重并发症的可能,需要严格进行围术期感染相关危险因素控制并进行赋形剂改良以降低严重并发症的发生率。

Background Triamcinolone acetonide can effectively treat various types of macular edema,which may cause many complications due to surgical procedures and preparation techniques.Objective To analyze the efficacy of intravitreal injection of triamcinolone acetonide for macular edema and the causes of complications.Methods Patients who underwent intravitreal triamcinolone acetonide injection in our hospital from January 2017 to June 2020 due to macular edema were selected,4 mg/0.1 mL of triamcinolone acetonide was injected into the vitreous cavity,and their visual acuity and complications at 1 day,1 month,3 months,and 6 months after surgery were evaluated.Results Totally 189 patients(104 males and 85 females,289 eyes)were included in the analysis,with age ranging from 45 to 82 years and a mean age of(53.3±9.6)years.The cause of macular edema was retinal vein occlusion in 97(51.3%)cases,diabetic retinopathy in 62(32.8%)cases,optic disc vasculitis(typeⅡ)in 20(10.6%)cases,and cataract extraction in 10(5.3%)cases.At 6-month postoperative follow-up,the patients'macular edema subsided,and their best-corrected visual acuity improved to varying degrees after injection[Md(IQR):0.2(0.1,0.4)vs 0.5(0.25,0.6),P<0.01].The results of correlation analysis showed a high correlation between postoperative visual acuity and preoperative visual acuity(r=0.655,P<0.01).Further analysis of the response of macular edema of different etiologies to drug injection in the four groups showed that visual acuity improved in all groups after drug injection,and the differences between the four groups were not statistically significant(P>0.05).The main postoperative complications were high intraocular pressure(42 cases,22.2%),cataract(46 cases,24.3%),subconjunctival hemorrhage(21 cases,6.3%),corneal epithelial detachment(7 cases,2.1%),non-infectious endophthalmitis(5 cases,1.5%)and infectious endophthalmitis(1 case,0.3%).Conclusion Intravitreous injection of triamcinolone acetonide can effectively treat macular edema and improve visual function,but there is still a possibility of serious complications.Strict control of perioperative infection related risk factors and improvement of excipients are needed to reduce the incidence of serious complications.