玻璃体手术联合曲安奈德在眼后段外伤的应用

目的探讨玻璃体视网膜手术联合曲安奈德(TA)玻璃体腔注射治疗眼后段外伤的疗效。方法眼后段外伤患者设联合组30例30眼、单纯组35例35眼。两组患者新鲜穿通伤首先清创缝合,1w～2w后行玻璃体切割术。合并白内障先切除混浊晶状体,有异物者取异物,伴有网脱者行气液交换或重水展平视网膜,裂孔行眼内光凝或冷凝,C3F8或硅油填充。在关闭切口前联合组患者加用TA4mg玻璃体腔注射。结果眼后段损伤有玻璃体积血、视网膜出血、异物(联合组20例、单纯组21例)、视网膜脱离,两组发生率(P>0.05)。两组患者眼后段异物均能取出。术后视力分别提高、不变、下降,联合组为76.7%、16.7%、6.7%;单纯组为60.0%、28.6%、11.4%。联合组比单纯组要好(P<0.05)。术后并发症:第1天前房反应2 以上联合组56.7%低于单纯组85.7%(P<0.05);高眼压和白内障发生率差异不明显(P>0.05);视网膜脱离联合组低于单纯组(P<0.05)。结论玻璃体视网膜手术联合TA玻璃体腔注射比单纯手术治疗眼后段外伤疗效要好。     

壳聚糖药膜植入脉络膜上腔治疗兔眼细菌性眼内炎

目的比较玻璃体腔注射万古霉素联合脉络膜上腔植入载有曲安奈德(triamci-nolone,TA)的壳聚糖膜与其玻璃体腔注射TA对兔外源性金黄色葡萄球菌的治疗作用。方法30只健康青紫蓝兔均于右眼内注射ATCC25923标准金黄色葡萄菌0.1×109CFU.L-1混悬液0.1mL。建立眼内炎模型后24h,将实验动物随机分为3组,均对右眼进行干预,每组10眼,A组玻璃体腔注射万古霉素、B组玻璃体腔注射万古霉素 TA混悬剂、C组玻璃体腔注射万古霉素 脉络膜上腔植入壳聚糖缓释药膜(载TA)。干预后每日裂隙灯及间接眼底镜观察;注射细菌后24h及干预后14d行B超检查;干预5d行玻璃体腔细菌培养;干预后14d摘除所有术眼于光镜下观察组织病理学改变。结果C组较A、B组炎症明显减轻。不同时间3组进行临床炎症评分,C组各项评分明显低于其他2个对照组,治疗后不同时间A、B、C3组总的炎症评分有显著性差异均为P=0.000,组间对比C组与A、B2组均有显著性差异P=0.000,A、B2组间无显著性差异(P<0.05)。细菌学培养检出率无统计学意义P=0.830;B超显示A、B、C3组视网膜脱离发生率有显著性差异(P=0.015);光镜下见C组眼部各组织结构完整,角膜、前房、玻璃体、视网膜病理学评分A、B、C3组间有显著性差异(P均为0.000),组间比较除A、B2组间视网膜评分有显著性差异(P=0.011),其余各组间各项病理评分均无显著性差异。结论壳聚糖药膜植入脉络膜上腔安全有效,可以成为治疗细菌性眼内炎的一种新的治疗方法。     

光动力疗法联合玻璃体腔曲安奈德注射治疗脉络膜新生血管

目的观察光动力疗法(PDT)联合玻璃体腔曲安奈德(TA)注射治疗老年黄斑变性和病理性近视引起的脉络膜新生血管(CNV)的近期疗效和安全性。方法16例经过视力、眼压、荧光素眼底血管造影(FFA)以及光相干断层扫描(OCT)等检查确诊的CNV患者的16只患眼进行PDT联合玻璃体腔TA注射治疗。其中,渗出型老年黄斑变性14例14只眼,病理性近视2例2只眼。16只眼中,12只眼在PDT治疗后72 h行玻璃体腔TA注射,4只眼在PDT 3个月~1年(平均9个月)后行玻璃体腔TA注射。第1年的平均治疗次数为1.1次。联合治疗后,采用与治疗前相同的条件和检查方法进行随访观察,随访时间3~18个月,平均随访时间18.6个月。对比观察治疗前后患者的最佳矫正视力、眼压、CNV病灶渗漏情况以及黄斑区视网膜厚度变化。结果16只眼中,7只眼视力提高,占43.8%;9只眼视力稳定,占56.2%。FFA显示CNV病灶在联合治疗后渗漏停止或减轻,OCT显示黄斑区视网膜水肿消退或减轻。1只眼暂时性眼压升高,占6.3%。经药物短期治疗后恢复正常。结论PDT联合玻璃体腔TA注射可以安全有效地治疗CNV,延缓视力下降,并且可以减少重复治疗的次数。     

玻璃体内注射曲安奈德联合玻璃体切割术治疗玻璃体积血

目的探讨玻璃体内注射曲安奈德(TA)联合玻璃体切割术治疗玻璃体积血的临床应用。方法对因玻璃体积血住院手术的患者192例进行回顾性分析,比较玻璃体内注射TA联合玻璃体切割术和单纯行玻璃体切割术治疗前和治疗后ld、10d、1个月、3个月时患者的最佳矫正视力、眼压、眼内炎症反应和眼底改变。结果TA注射组在1个月、3个月最佳矫正视力高于单纯手术组,术后眼内炎症反应较单纯手术组降低,差异有统计学意义。结论与单纯玻璃体切割术比较,玻璃体内注射TA联合玻璃体切割术治疗玻璃体积血能在短期内获得更高的最佳矫正视力,并减少眼内炎症反应。     

Changes of intraocular pressure after intravitreal injection of 4mg triamcinolone acetonide in treatment of macular edema

AIM: To investigate the changes of intraocular pressure (IOP) and associated factors of IOP elevation after 4mg intravitreal injection of triamcinolone acetonide (IVTA) in treatment of macular edema. ·METHODS: The study is prospective, consecutive, and non-comparative interventional case series including 93 eyes with macular edema associated with retinal vein occlusion ( =54 eyes) or diabetic retinopathy ( =39 eyes), which received 4mg IVTA injection. The change in IOP was followed for all cases at pre-operation and 14 days, 1, 2, 3, 4, 5, and 6 months post-operation. Associated factors of IOP elevation were examined regarding baseline IOP, causal disease, age and gender. ·RESULTS: IOP increased significantly ( <0.001) at 14 days 16.02 ± 2.45mmHg after injection and peaked at 18.80 ± 6.20mmHg at 2 months post-injection ( <0.001) from 14.85± 2.55 mmHg preoperatively. An IOP rise to the value higher than 21mmHg was observed in 2 (2.2%) eyes 14 days after injection and which was observed in 14 (15.1%), 18 (19.5%), 9(9.6%), 4(4.3%), 0, and 0 eyes respectively at 1, 2, 3, 4, 5, and 6 months after injection. One eye (1.07%) showed pressure elevation of over 5mmHg than baseline 14 days after injection and IOP peaked to 22mmHg (23.7%) at 2 months after injection. Five (5.3%) eyes had an increase of 10mmHg at 1 month and IOP peaked to 12mmHg (12.9%) at 2 months after injection. The rise in IOP was statistically associated with younger age (correlation coefficient -0.18- -0.29, <0.05), high baseline IOP (correlation coefficient 0.52-0.79, all <0.001), and the presence of diabetes mellitus (correlation coefficient 0.23, <0.001) but independent of gender (correlation coefficient -0.002-0.04, all >0.05). In all eyes, IOP could be lowered to the normal range with topical medication, without development of glaucomatous optic nerve head changes. ·CONCLUSION: Elevated IOP after 4mg IVTA injection is common and patients should be monitored beyond 6 months post-injection. In all the cases, IOP can be normalized by topical medication. Patients with high baseline IOP, diabetic retinopathy, and younger age should be carefully monitored for an elevated IOP.     

玻璃体腔注射曲安奈德治疗视网膜静脉阻塞黄斑水肿

目的：比较玻璃体腔注射曲安奈德和传统方法治疗视网膜静脉阻塞黄斑水肿的疗效。方法：共有21例因视网膜静脉阻塞导致黄斑水肿的患者纳入此项临床研究。接受治疗前所有的患者均进行了全面的眼科检查，并随机分为两组。实验组9例患者进行玻璃体腔注射4mg曲安奈德治疗；对照组12例患者接受传统方法治疗。结果：治疗前，对照组视力（logMAR）为1．20±0．38，而实验组为1．64±0．31。治疗后1mo，对照组的视力改善到0．98±0．54（logMAR），而曲安奈德治疗组改善到0．87±0．61（logMAR）。实验组和对照组之间视力改善有显著差异（P〈0．01）。结论：研究结果显示，尽管实验组和对照组的患者视力均有改善，但治疗视网膜静脉阻塞黄斑水肿，玻璃体腔注射曲安奈德比传统方法更有效。     

Changes of aqueous vascular endothelial growth factor and interleukin‐6 after intravitreal triamcinolone for branch retinal vein occlusion

Background: To investigate sequential changes of aqueous vascular endothelial growth factor (VEGF) and interleukin (IL)‐6 in macular oedema secondary to branch retinal vein occlusion after single intravitreal injection of triamcinolone acetonide (IVTA). Methods: We recruited 10 healthy controls and 30 patients at Chonnam National University Hospital, Gwangju, Korea. Aqueous and plasma levels of VEGF and IL‐6 were measured by enzyme‐linked immunosorbent assay at the time of IVTA and 3 months later. Non‐response to IVTA was defined as showing persistent macular oedema based on a reduction of central macular thickness by less than 20% from baseline measurements by optical coherence tomography and vision improvement by less than 0.3 logMAR. Fluorescein angiography was performed 6 months after IVTA. We compared aqueous levels of VEGF and IL‐6 between responders and non‐responders. Results: The aqueous levels of VEGF and IL‐6 were significantly higher in 12 non‐responders than in 18 responders at baseline measurements (511 ± 245 pg/mL vs. 230 ± 108 pg/mL, P < 0.001; 38 ± 31 pg/mL vs. 16 ± 13 pg/mL, P < 0.001, respectively). Aqueous levels of VEGF were still higher in non‐responders (312 ± 64 pg/mL) 3 months after IVTA, and aqueous levels of VEGF in responders returned to normal (86 ± 21 pg/mL, P < 0.001). Aqueous levels of IL‐6 normalized in all patients 3 months after IVTA. Fluorescein angiography revealed that non‐responders showed higher frequencies of macular ischaemia and ischaemic branch retinal vein occlusion. Conclusions: IL‐6‐independent VEGF secretion may contribute to persistent macular oedema associated with ischaemic BRVO after IVTA.     

高效液相色谱法测定曲安奈德乳膏的含量

目的建立曲安奈德乳膏的含量测定方法。方法采用高效液相色谱法测定曲安奈德乳膏的含量,色谱柱为Nova-Park C18柱(4.0mm×300mm,4μm),流动相为甲醇-乙醚-水(68∶2∶30),流速为1mL.min-1,检测波长为240nm。结果曲安奈德浓度在6.8~108.8mg.L-1浓度内与其峰面积呈良好的线性关系(r=0.9996)。回收率为101.45%,RSD为0.50%。结论本法简便,准确,灵敏度高,重现性好,可用于曲安奈德乳膏的含量测定。     

曲安奈德玻璃体注射治疗视网膜中央静脉阻塞继发黄斑水肿

目的 观察玻璃体腔曲安奈德注射(intravitreal triamcinolone acetonide,IVTA)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发的黄斑水肿的近期疗效和并发症.方法 对30例(30只眼)CRVO继发的严重黄斑水肿患者,患眼行IVTA 4mg/0.1ml,观察治疗前和治疗后1 d、3 d、1周、1个月、3个月时患者的最佳矫正视力、眼压、眼内炎性反应、晶体、眼底改变,光学相干断层扫描(optic coherenttomography,OCT)测定黄斑区视网膜厚度变化.结果 30只眼中,有22只眼(73%)视力提高,3只眼(10%)视力不变,2只眼(7%)继发性青光眼,2只眼(7%)并发性白内障,1只眼(3%)视网膜脱离.LogMAR视力治疗前为0.78±0.50,治疗后1周、1个月、3个月时分别为0.62±0.48,0.45±0.37,0.31±0.28.黄斑中心凹平均厚度治疗前为(589±132)μm,治疗后1周、1个月、3个月时分别为:(341±122)μm;(201±61)μm;(162±41)μm.治疗前后比较差异有统计学意义(P＜0.01).30只眼中有5只眼(17%)治疗后暂时性眼压轻度升高,经局部药物短期治疗后恢复正常;2只眼(7%)继发性青光眼,给与小梁切除术治疗;2只眼(7%)并发性白内障;1只眼(3%)视网膜脱离,给与激光光凝治疗.结论 IVTA可以在短期内有效地治疗CRVO继发的黄斑水肿,但其并发症不容忽视.     

绿激光联合曲安奈德治疗视网膜中央静脉阻塞的评估

目的:评价绿激光联合曲安奈德在视网膜中央静脉阻塞中的疗效。方法:2006-01/2007-10收治视网膜中央静脉阻塞的44例(49眼),随机分为绿激光联合曲安奈德为治疗组和单纯激光治疗为对照组,随访3mo,比较两组患者视力改善和黄斑水肿消退的情况。结果:两组患者治疗后视力及黄斑水肿均有明显改善,但前者效果优于后者,P<0.05。结论:绿激光联合曲安奈德治疗视网膜中央静脉阻塞在较短时间内即可促进黄斑水肿消退,提高患者视力。