使用维替泊芬光动力疗法联合玻璃体内注射曲安奈德治疗脉络膜新生血管

Purpose: To examine the 12- month results of a group of patients treated with combined photodynamic therapy (PDT)- with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age- related macular degeneration (AMD). Design: Noncomparative case series. Participants: Twenty- six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT (newly treated group)- . Thirteen patients with prior PDT therapy who experienced visual loss while being treated with PDT alone comprised the remainder (prior PDT group). Methods: Patients with CNV were treated with PDT, immediately followed by an intravitreal injection of4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3- month follow- up intervals. Main Outcome Measures: Visual acuity and retreatment rate. Results: In the newly treated group, the mean acuity change was an improvement of 2.5 lines (last observation carried forward [LOCF], + 2.4 lines; P=0.011, Wilcoxon signed ranks test, as comparedwith baseline acuity) for patients completing the 12- month follow- up. In the prior PDT group, the mean change was an improvement of + 0.44 lines (LOCF, + 0.31 lines; P=0.53). Retreatment rates were 1.24 for the newly treated group and 1.2 for the prior PDT group over the first year. Ten patients (38.5% ) developed an intraocular pressure (IOP) of >24 mmHg during follow- up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis. Conclusion: Although the number of patients in this pilot study was limited, the improvement of acuity and the reduced treatment frequency in these patients suggest that combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first- line therapy, merits further investigation. Elevated IOP seems to be the most frequent early side effect of the treatment.

玻璃体内注射曲安奈德对眼压的影响

To analyze the incidence of intraocular pressure (IOP) elevation following int ravitreal triamcinolone injection. Retrospective observational case series. Char ts of patients undergoing intravitreal triamcinolone injection in one clinical p ractice were reviewed. A pressure elevation was defined as a pressure of 24 mm H g or higher during follow up. There were 89 patients with a mean age of 76.4 ye ars. The mean baseline IOP was 14.9 mm Hg with a mean change of 8.0 mm Hg. Thirt y six patients (40.4%) experienced a pressure elevation to 24 mm Hg or higher at a mean of 100.6 days (SD= 83.1 day) after treatment. Of nonglaucomatous patie nts with baseline IOP of 15 mm Hg or above, 60.0%experienced a pressure elevati on, compared with only 22.7%of those with baseline pressures below 15 mm Hg (re lative risk=2.1, P< .01). In glaucoma patients, 6 of 12 (50%) experienced a pre ssure elevation, and this elevation was not correlated with baseline pressure. T hirty two patients (36.0%) received repeat injections, and there was no differ ence in the incidence of procedure elevation in patients receiving multiple inje ctions versus those receiving a single injection. Pressure elevation was control led with topical medications in all patients. IOP elevation after intravitreal t riamcinolone injection is common and may take an extended period of time to mani fest. The proportion of patients who developed a pressure elevation to at least 24 mm Hg was much higher for those with baseline IOP 15 mm Hg or greater.