后筋膜下注射曲安奈德治疗难治性糖尿病性黄斑水肿

Purpose: To evaluate posterior subtenon injection of triamcinolone acetonide for refractory diabetic macular edema (DME). Design: Retrospective, interventional, case series. Methods: setting: Clinical practice. patient population: Patients with persistent clinically significant DME involving the center of the fovea 3 or more months after one or more treatments of focal macular photocoagulation were included. Exclusion criteria were a history of corticosteroid- responsive intraocular pressure (IOP) rise, intraocular surgery within 3 months, and any laser treatment within 1 month. procedure: All patients received an ophthalmic history and examination including best- corrected Snellen visual acuity, IOP measurement, anterior segment examination including evaluation of lens status with LOCS II criteria, dilated fundus examination, and a posterior subtenon injection of 40mg triamcinolone acetonide at baseline. Patients were reevaluated at 1, 3, 6, and 12 months after injection. Results: Seventy- three injections were performed in 63 eyes of 50 patients. The mean baseline visual acuity was 20/80. Mean visual acuity significantly improved to 20/50 at 1 month, then stabilized to 20/65 at 3 months, 20/68 at 6 months, and 20/63 at 12 months. Complication swere rare,with a transient significant rise in intraocular pressure at the 3- month evaluation and ptosis in two patients. Conclusions: Visual acuities remained stable or improved over a 12- month period after posterior subtenon triamcinolone injections for refractory DME. There was a statistically significant improvement in visual acuity at 1 month.

并发脉络膜上腔出血:一个病例对照研究

To identify the risk factors, prognostic factors, and clinical outcomes of pat ients with perioperative appositional suprachoroidal hemorrhage (ASCH). Case-co ntrol study. Tertiary referral center. Subjects included all patients with perio perative ASCH documented by B-scan ultrasound between May 1990 and March 2001. Two or three control patients were selected for each case, matched by surgeon, p rocedure, and date of surgery within 1 month. Surgery was performed as necessary . main outcome measures. The odds of ASCH associated with clinical risk factors. secondary outcome measure: visual acuity. Thirty-seven cases with ASCH were identified. Ninety-two proce dure-and surgeon-matched control subjects (2.48:1) were selected. Twenty-six cases (71%) of ASCH were related to a glaucoma operation. Risk factors for the development of ASCH included previous vitrectomy (P=.003, odds ratio of 12) and older age (P=.007, odds ratio 1.57/decade of increasing age). Hypertension was f ound to be protective (P=.02, odds ratio of 0.33). Factors associated with a poo r visual outcome in patients with ASCH included apposition >30 days (P=.01), his tory of uveitis (P=.04), history of dry age-related macular degeneration (P=.05 ), and history of extracapsular cataract extraction (P=.05). Median pre-ASCH vi sual acuity was 20/100, and final median visual acuity was 20/1600. Risk factors for the development of ASCH include previous vitrectomy and older age. Patients with these risk factors should be informed of their greater chance of poor visu al acuity and anatomic outcomes secondary to the development of ASCH.

玻璃体内曲安奈德注射后假定无菌性眼内炎

BACKGROUND AND OBJECTIVE: To report acute postoperative, presumed sterile endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA). PATIENTS AND METHODS: Retrospective, interventional, multicenter study of patients with acute sterile endophthalmitis following IVTA injection. RESULTS: A total of 922 IVTA injections were performed. Eight eyes of 8 patients with presumed sterile endophthalmitis were identified. The incidence of endophthalmitis was 0.87% (95% confidence interval, 0.38% to 1.70% ). Median time to presentation was 1.5 days (range, 1 to 7 days). Median presenting visual acuity was 20/563 (range, 20/80 to light perception). Initial treatment included vitreous tap and injection of antibiotics (n=4), pars plana vitrectomy and injection of intravitreal antibiotics (n=2), or systemic treatment alone with oral levofloxacin (n=2). Six of 6 intraocular cultures were sterile. Median follow-up was 5.9 months (range,4 to 9 months) with a median visual acuity at last follow-up of 20/75 (range, 20/40 to counting fingers). CONCLUSIONS: Acute presumed sterile endophthalmitis following IVTA injection presents early in the postoperative period. Visual outcomes are generally good.