曲安奈德联合激光光凝治疗视网膜静脉阻塞继发黄斑水肿

目的：观察玻璃体腔内曲安奈德( trialcinolone acetonide, TA)注射联合黄斑格栅样光凝治疗视网膜静脉阻塞引起黄斑水肿的疗效分析。
　　方法：检眼镜、眼底血管造影( FFA )、光学相干断层扫描( OCT)检查证实的由视网膜静脉阻塞引起的黄斑水肿患者35例35眼,玻璃体内注射TA 2lg,1~4wk内黄斑水肿减轻后行黄斑格栅样光凝,随访6lo,观察视力、眼压、晶状体,OCT 观察黄斑厚度改变,FFA 观察眼底毛细血管渗漏情况。
　　结果：视网膜中央静脉阻塞( central retinal vein occlusion, CRVO)中非缺血型10眼,缺血型14眼；视网膜分支静脉阻塞( branch retinal vein occlusion, BRVO)中非缺血型4眼,缺血型7眼。最终视力提高者19眼,不变者11眼,比术前降低者5眼。 OCT检查黄斑中心凹形态恢复正常者9眼,FFA提示黄斑区荧光素渗漏与术前相比消失或明显减轻；黄斑囊样水肿明显改善者21眼,FFA 提示渗漏比术前减轻；无改善者5眼,FFA 提示黄斑区渗漏比术前加重或不变。
　　结论：玻璃体腔内注射TA 2 lg联合黄斑格栅样光凝治疗视网膜静脉阻塞继发黄斑水肿,可以明显减轻由静脉阻塞引起的黄斑水肿,并提高患者视力,是一种有效可行的方法。

Triamcinolone acetonide with laser photocoagulation for macular edema caused by retinal vein occlusion

AIM:To evaluate the effect of intravitreous injection of triamcinolone acetonide(TA)for macular edema caused by retinal vein occlusion.

METHODS:Thirty-five patients(35 eyes)with macular edema caused by retinal vein occlusion, diagnosed by ophthalmoscopy, optical coherence tomography(OCT), and fundus fluorescein angiography(FFA), were intravitreously injected with 2mg TA, then grid pattern laser photocoagulation was conducted after macular edema was relieved for 1-4wk. The visual acuity, intraocular pressure(IOP), lenses, the retinal thickness, and vascular leakage were observed during the 6mo follow-up period.

RESULTS:In central retinal vein occlusion(CRVO)group, 10 eyes were nonischemic,14 eyes were ischemic; in branch retinal vein occlusion(BRVO)group, the number was 4 and 7 eyes respectively. The final vision acuity improved in 19 eyes, remained unchanged in 11 eyes, decreased in 5 eyes. Nine eyes showed normal macular thickness after injection of TA by OCT, and the changes on FFA was disappeared or significantly improved; cystoid macular edema was impoved in 21 eyes and the changes on FFA showed that the fluorescein leakage was improved compared with that before treatment; the situation did not chang in 5 eyes, and the FFA showed that the leakage became even worse or unchanged.

CONCLUSION:Intravitreous injection of 2mg TA with laser photocoagulation can be used to treat macular edema caused by retinal vein occlusion effectively, relieve the macular edema and improve the visual acuity.