玻璃体腔注射曲安奈德治疗黄斑水肿的临床研究

曲安奈德作为一种长效糖皮质激素,采用玻璃体内注射的给药方式,治疗各种原因所致的黄斑水肿,显示出良好的临床效果和较为广泛的应用前景。近年来,国内外学者对其进行了大量的研究,并取得了一些进展。本文就其治疗黄斑水肿的作用机制及其在临床应用中的安全性、有效性和远期疗效简要综述。     

Filter Connected with Three-way Cock in Remove of the Vehicle in Triamcinolone Acetonide

Intravitreal injection of triamcinolone acetonide (TA) was widely used in thepast years because it has potent effect on the treatment of age-related macular degeneration (AMD), branch retinal vein occlusion ( BRVO) and cystoid macular edema (CME) caused by uveitis or proliferative diabetic retinopathy ( PDR) [1]. In the year of 2000, Peyman etal[2] reported that transparent vitreous and posterior hyaloid cortex can be visualized during pas plana vitrectomy (PPV) by TA. Through this met…     

曲安奈德囊内注射治疗耳廓假性囊肿105例

目的 观察曲安奈德囊内注射治疗耳廓假性囊肿的临床疗效。方法 对曲安奈德囊内注射术与磷酸地塞米松囊内冲洗加石膏固定术治疗耳廓假性囊肿的临床资料进行分析。结果 曲安奈德囊内注射术优于磷酸地塞米松囊内冲洗加石膏固定术．两组临床疗效比较差异有极显著意义（P〈0.001），且曲安奈德囊内注射组（105例）治愈率为100％，无一例复发，无明显并发症，愈后耳廓无增厚或畸形。结论 曲安奈德囊内注射术优于磷酸地塞米松囊内冲洗加石膏固定术，重复多次抽液及囊内注药是治疗本病的关键。     

曲安奈德对高糖培养人视网膜色素上皮细胞细胞间黏附分子-1表达的影响

目的:观察曲安奈德(TA)对高浓度葡萄糖条件下体外培养人视网膜色素上皮(hRPE)细胞细胞间黏附分子-1(I-CAM-1)表达的影响。方法:用MTT方法检测不同浓度(0.01,0.10和1.00g/L)的TA对hRPE细胞增生的影响,用免疫荧光法检测加用和未加用0.10g/LTA的30.0mmol/L葡萄糖作用1,2和3d后hRPE细胞表面ICAM-1的表达强度。结果:在0.01～1.00g/L浓度TA的作用下,hRPE细胞生长受到抑制,呈剂量依赖性和时间依从性。加用0.10g/LTA的30.0mmol/L葡萄糖作用1,2和3d后,hRPE细胞表面荧光染色密度分别比未加用TA的30.0mmol/L葡萄糖作用下荧光着色减弱20%,25%和50%,有统计学显著性差异(P<0.05)。结论:TA可以抑制体外高浓度葡萄糖培养的hRPE细胞的增生,也抑制高糖作用下hRPE细胞表面的ICAM-1表达。     

曲安奈德对缺氧条件下恒河猴脉络膜视网膜内皮细胞VEGF表达的影响

目的:研究曲安奈德对缺氧条件下恒河猴视网膜脉络膜内皮细胞VEGF表达的影响,探讨曲安奈德治疗视网膜脉络膜新生血管的作用机制。方法:采用免疫组化图像分析和半定量RT-PCR方法,检测曲安奈德对正常和缺氧条件下RF/6A细胞VEGF表达的影响。结果:缺氧条件下VEGF蛋白在细胞胞质中的染色强度明显增强,加入曲安奈德后VEGF蛋白在细胞胞质中的染色强度明显减弱,正常条件下的VEGF蛋白的A值为276.8±8.6;正常加药组的A值为137.1±10.2;缺氧条件下的A值为406.1±8.8;缺氧加药组的OD值244.2±12.8。半定量RT-PCR表明VEGFmRNA在正常对照组RF/6A细胞中的相对表达量为1.38±0.05;缺氧对照组RF/6A细胞中的相对表达量为5.41±0.06;正常加药组RF/6A细胞中的相对表达量为0.70±0.06;缺氧加药组RF/6A细胞中的相对表达量为4.23±0.05,以上两种方法,缺氧对照组与正常对照组比较、缺氧对照组与缺氧加药组比较、正常对照组与正常加药组比较差异均有显著性意义(P=0.000)。结论:缺氧状态下RF/6A细胞中VEGF的表达明显增高,曲安奈德能显著抑制正常和缺氧状态下RF/6A细胞中VEGF的表达。     

玻璃体内注射曲安奈德治疗黄斑水肿后黄斑区形态和功能的研究

目的观察玻璃体内注射曲安奈德(intravitreal injection of triamcinolone acetonide,IV-TA)治疗黄斑水肿后视网膜形态和功能的变化。方法对黄斑水肿的患者35例37只眼经玻璃体内注射曲安奈德后定期随访6月,对比分析治疗前后的最佳矫正视力、光学相干断层扫描、视野检查、眼底荧光造影及眼压的变化情况。统计学方法采用SPSS统计软件进行配伍组设计的两因素方差分析,差异有显著性时用S-N-K法行q检验两两比较,相关因素用Pearson相关分析。结果全部患者IVTA后最佳矫正视力均比术前提高(P<0.05)。OCT测量黄斑区视网膜厚度,IVTA前黄斑区视网膜厚度为(602.53±191.27)μm,IVTA后1、3、6月分别为(271.80±93.77)μm、(207.87±81.88)μm、(273.87±187.17)μm,IVTA前后相比有显著性差异(P<0.05)。复发患者再次IVTA后CMT仍显著降低。在视野检查中,IVTA后1、3、6月黄斑区中心凹阈值均比术前有明显改善;IV-TA后平均缺损绝对值较IVTA前减小;IVTA后模式标准差值较IVTA前减小。IVTA前后最佳矫正视力与黄斑区视网膜厚度为显著负相关(P<0.05),与黄斑中心凹光敏感度呈高度正相关(P<0.01)。结论IVTA治疗黄斑水肿随访半年,患者中心视力显著提高,黄斑水肿减轻,荧光造影显示黄斑区荧光渗漏减少甚至部分患者无渗漏。黄斑区视网膜厚度显著降低,视网膜光敏感度有显著提高,视野缺损也有所降低,中心暗点减少。IVTA后3~6月出现黄斑水肿复发,再次行IVTA病情仍可有明显改善。     

曲安奈德辅助显示玻璃体切割术中残留的玻璃体后皮质

目的探讨在曲安奈德(triamcinoloneacetonide,TA)辅助的PPV手术中行人工玻璃体后脱离后,玻璃体皮质的残留情况。方法90例患者行TA辅助的经睫状体平坦部玻璃体切割术,其中增殖性糖尿病视网膜病变34例(34只眼)、糖尿病性黄斑水肿16例(16只眼)、特发性黄斑裂孔17例(17只眼)、孔源性视网膜脱离23例(23只眼)。在常规的人工玻璃体后脱离后,在TA辅助下残留的玻璃体皮质被分为三种类型:弥散型、局限型和无残留。结果79.4%的增殖性糖尿病视网膜病变患者残留玻璃体皮质为弥散型,11.8%为局限型,8.8%为无残留;56.3%糖尿病性黄斑水肿患者为弥散型,25.0%为局限型,18.7%为无残留;特发性黄斑裂孔患者29.4%为弥散型,17.6%为局限型,53.0%为无残留;39.1%孔源性视网膜脱离患者为弥散型,17.4%为局限型,43.5%为无残留。结论常规的人工玻璃体后脱离后玻璃体皮质残留仍然存在,糖尿病患眼容易表现为弥散型。     

曲安奈德玻璃体腔内注射治疗白内障术后慢性黄斑囊样水肿

目的观察曲安奈德玻璃体腔内注射治疗白内障术后慢性黄斑囊样水肿的临床疗效。方法对38例38眼白内障术后发生慢性黄斑囊样水肿的患者,行曲安奈德玻璃体腔内注射进行治疗,观察注射后1周、1月、2月、3月患者视力及黄斑中心视网膜厚度的变化及并发症。结果曲安奈德玻璃体腔内注射后,所有患者最佳矫正视力均有不同程度提高,相应的黄斑中心视网膜厚度逐渐变薄,注射后并发症包括球结膜下出血、眼压升高及黄斑囊样水肿复发。结论曲安奈德玻璃体腔内注射对白内障术后慢性黄斑囊样水肿是一种安全、有效的治疗方法,但黄斑囊样水肿复发的原因及再次治疗时机有待进一步观察。     

Inhibitory effect of triamcinolone acetonide on corneal neovascularization

Background Corneal neovascularization (NV) plays an important role in the pathogenesis of corneal disorders. Recently, triamcinolone acetonide (TA) has been reported as a potential treatment for ocular angiogenesis. However, there are no reports on the inhibitory effect of TA on the corneal NV. Methods Triamcinolone acetonide (2 mg) was administered to four rabbits' eyes by a subconjunctival injection immediately after a basic fibroblast growth factor (bFGF)-pellet was placed into the cornea. As a control, four eyes received an injection of distilled water. Four weeks later, the inhibition of corneal NV was evaluated as the percentage ratio of the vessel invasion area to the area that was sandwiched between the pellet and the limbus cornea. To identify the characteristic appearance of new corneal vessels, the control cornea was examined by using the antibody of vascular endothelial growth factor (VEGF). To confirm TA concentration in TA-treated corneas, the TA level was measured using high-performance liquid chromatography. Results Neovascularization from the limbus to the pellet was detected in control eyes 4 weeks after the bFGF pellet implantation. TA-treated eyes demonstrated the inhibition of the neovascular response to the pellet. The severity of NV as compared between control and TA-treated eyes was statistically significant (P<0.05). Morphologically, new vessel growth was shown in the control cornea, and endothelial cells of new vessels were positively stained with the antibody of VEGF. TA concentration in TA-treated corneas at 2 weeks showed 63.5±42.8 μg/g (n=4, mean ± SD), while TA was not detected in control and TA-treated corneas at 4 weeks. The level of TA was effectively maintained for at least 2 weeks after the subconjunctival injection. Conclusion We have demonstrated that subconjunctival TA administration inhibited rabbit corneal NV. This agent may prove useful in the treatment of corneal angiogenic disorders. No human subjects are involved as experimental animals were used in this study     

HPLC法测定曲氯霜中氯霉素和醋酸曲安奈德的含量

建立HPLC法测定曲氯霜中氯霉素和醋酸曲安奈德的含量.选用Shim-pack VP-ODS C18柱,甲醇-水-乙醚(65352)为流动相,流速1.0ml·min-1,检测波长240nm,醋酸曲安奈德在0.003116～0.06232mg·ml-1浓度范围内线性关系良好,r=0.9999(n=6);平均回收率为100.70%,RSD为1.7%(n=9).氯霉素在0.05132～1.0264mg·ml-1浓度范围内线性关系良好,r=0.99997(n=6);平均回收率为101.74%,RSD为0.8%(n=9).本法定量准确、操作简便.