玻璃体腔内注射曲安奈德治疗慢性顽固性人工晶状体眼黄斑囊样水肿的临床研究

Clinical Research of Intravitreal Triamcinolone Acetonide for Refractory Chronic Pseudophakic Cystoid Macular Edema

目的:评价玻璃体腔内注射曲安奈德治疗慢性顽固性人工晶状体眼黄斑囊样水肿的有效性和安全性。方法:非随机回顾性研究白内障术后慢性顽固性人工晶状体眼黄斑囊样水肿(Cystoid Macular Edema, CME)的患者23例23眼。患者CME持续6~10月。所有CME患者接受1 mg曲安奈德玻璃体腔内注射,随访12月。疗效评价指标有最佳矫正视力,裂隙灯显微镜检查,血管渗漏的荧光血管造影及眼压,光学相干断层扫描测量黄斑中心凹视网膜厚度和相关并发症的处理。结果:所有CME患者玻璃体腔注射后视力均有提高;视力提高与治疗前原有视力和是否伴有黄斑病变相关。裂隙灯显微镜检查显示23例患者CME均有好转,治疗后荧光血管造影显示血管渗漏均有减轻。11例出现一过性眼压升高,用降眼压药物均易控制;未见其它并发症。延长随访时间,发现视力有轻度回退且需要再次注射,9例患者分别治疗2~5次,平均间隔时间8周(2.5~24周)。结论:本研究显示玻璃体腔内注射曲安奈德对治疗白内障术后顽固性人工晶状体眼黄斑囊样水肿是安全有效的,可使患者视力显著提高,使CME缓解或消失,治疗痛苦小,但长期随访发现有复发和视力回退,部分患眼需再次注射。研制玻璃体腔内药物缓释系统有利于治疗该病。对于该技术的更确切疗效、安全性、治疗时机和适应证尚需进行前瞻性随机化临床试验。

Objective: To determine the safety and efficacy of intravitreal triamcinolone acetonide (TAAC) injections in patients with refractory cystoid macular edema (CME) after cataract extraction. Methods: In this nonrandomized retrospective case review, 23 eyes of 23 patients with a history of pseudophakic CME recalcitrant to current standard treatment modalities were enrolled. The mean duration of the CME was 6~10 months. The patients received intravitreal injections of 1 mg of TAAC and were followed for a mean of 12 months. The main outcome measures included visual acuity, the presence of CME on biomicroscopic examination, angiographic evidence of perifoveal leakage, intraocular pressure (IOP), measurement of the optical coherence tomography on central macular thickness (CMT), and complications related to treatment. Results: The visual acuity increased in all patients. The magnitude of improvement was mainly restricted by underlying macular pathology and correlated well with the level of visual acuity at entry into the study. The presence of CME improvement occurred on biomicroscopic examination in all patients, Angiographic improvement occurred in all patients. 11 cases had temporary increases in IOP, which were easily controlled with topical medications. No other adverse effects could be attributed to this technique. Repeated injections were required. After prolonged follow-up, it was found that the visual acuity had a slight regression and needed to be injected again. 9 patients were treated respectively 2~5 times with an average interval of 8 weeks (2.5~24 weeks). Conclusions: Intravitreal administration of TAAC was safe and effective in recalcitrant cases of pseudophakic CME with a beneficial effect on the macular edema and visual acuity. Long-term follow-up found a recurrence and eyesight back. Repeated injections were required in part of all eyes. The development of a sustained- release intravitreal drug-delivery system would be beneficial. A prospective randomized study is needed to determine with accuracy the efficacy, safety, and exact timing of this technique and possibly to recognize subtypes with a more favorable response.