曲安奈德玻璃体注射治疗视网膜分支静脉阻塞继发黄斑水肿

目的观察玻璃体腔曲安奈德注射(intravitrealtriamcinoloneacetonide,IVTA)治疗视网膜分支静脉阻塞(branchretinalveinocclusion,BRVO)继发的黄斑水肿的近期疗效和安全性。方法对23例(23眼)BRVO继发的严重黄斑水肿患者,患眼行IVTA4mg/0.1ml,观察治疗前和治疗后1天、3天、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(opticcoherenttomography,OCT)测定黄斑区视网膜厚度变化。结果所有23眼中,有20眼(86.9%)视力提高,3眼(13.1%)视力不变。LogMAR视力治疗前为:0.75±0.48,治疗后一周、一个月、三个月时分别为:0.57±0.43;0.38±0.32;0.29±0.29。黄斑中心凹平均厚度治疗前为611±149μm,治疗后一周、一个月、三个月时分别为:325±129μm;208±55μm;173±38μm。治疗前后比较差异有统计学意义(P<0.01)。23眼中有3眼(13.1%)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。所有患眼未出现眼内炎、白内障、视网膜脱离、玻璃体出血等并发症。结论IVTA可以在短期内安全有效地治疗BRVO继发的黄斑水肿。     

Intravitreal triamcinolone acetonide versus bevacizumab therapy for macular edema associated with branch retinal vein occlusion

Purpose  

To compare visual outcomes after intravitreal triamcinolone acetonide (IVTA) injection and intravitreal bevacizumab (IVB) administration for treatment of macular edema associated with branch retinal vein occlusion (BRVO).     

Intravitreal versus retrobulbar injections of triamcinolone for macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the short-term effect of intravitreal versus retrobulbar injection of triamcinolone acetonide for the treatment of macular edema caused by branch retinal vein occlusion. DESIGN: Randomized clinical trial. METHODS: Sixty eyes of 60 patients who had macular edema associated with branch retinal vein occlusion were randomly assigned to receive a single intravitreal injection (4 mg) or repeated retrobulbar injections (40 mg, three times) of triamcinolone. These injections (first injection in the retrobulbar group) were given approximately 1 week after focal laser photocoagulation. Using optical coherence tomography, the central retinal (foveal) thickness and total macular volume were measured before and at 1 and 3 months after injection. Visual acuity, intraocular pressure, and the incidence of reinjection were also examined. Fifty-two patients (86.7%) completed the 3-month follow-up. RESULTS: The mean foveal thickness and total macular volume decreased significantly after either intravitreal or repeated retrobulbar triamcinolone injections. Foveal thickness and macular volume were significantly less after intravitreal injection than after repeated retrobulbar injections, although there had been no significant differences at baseline. The percent reductions in foveal thickness and macular volume were also greater after intravitreal injection than after retrobulbar injections. Improvement in visual acuity was significantly better after intravitreal injection than after the retrobulbar injections. The incidence of intraocular pressure rise (to > or =20 mm Hg) was greater in the intravitreal group than in the retrobulbar group, but this was readily controlled by the use of antiglaucoma medications. After completion of the 3-month follow-up, 24 patients (46.2%) underwent reinjection. The need for reinjections was significantly greater in the retrobulbar group than in the intravitreal group (P = .0001). CONCLUSIONS: A single intravitreal injection of triamcinolone is significantly more effective than are repeated retrobulbar injections in reducing macular edema associated with branch retinal vein occlusion, and leads to greater improvement in visual acuity.     

Intravitreal triamcinolone treatment for macular edema associated with central retinal vein occlusion and hemiretinal vein occlusion

PURPOSE: To assess the efficacy of intravitreal triamcinolone treatment for macular edema from central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (HRVO). METHODS: This study was a retrospective medical records review of 24 eyes of 24 patients (mean age, 71 years) that were injected with 4 mg of intravitreal triamcinolone acetonide for treatment of macular edema due to CRVO (n = 21) and HRVO (n = 3). Of the 24 eyes, 14 were injected once, 6 were injected twice, 3 were injected 3 times, and 1 received 4 injections. Mean follow-up time was 10 months (range, 3-24 months). The average time between onset of symptoms and first injection was 5.4 months (range, 2-48 months). Available documents on pre- and postinjection optical coherence tomography central foveal thickness in 23 of 39 total injections were evaluated. RESULTS: All injections resulted in reduction in central foveal thickness as determined by optical coherence tomography. The mean central foveal thickness decreased to 55% of preinjection values ([n = 23] 635 vs. 352 mum, respectively; P < 0.001). The average gain in visual acuity was 1.3 Snellen lines (range, -3-7) over the course of the study period. Ten eyes gained > or =2 lines of visual acuity, 3 eyes improved 1 line, 7 eyes remained the same, and 4 eyes worsened. There was no correlation between improvement in foveal thickness and corresponding visual gain (P = 0.24). None of the eyes of diabetic patients (n = 6) or patients with ischemic CRVO (n = 2) improved in visual acuity. The difference in mean baseline (20/167) and mean final visual acuity (20/91) was statistically significant (P = 0.015). The mean best postinjection visual acuity (20/67) was also significantly higher than the mean final visual acuity (P = 0.019). When diabetic and ischemic CRVO patients were excluded, the difference between mean baseline visual acuity and mean final visual acuity was found to be highly significant ([n = 16] 20/133 vs. 20/67, respectively; P < 0.001), while mean final and best postinjection visual acuities (20/50) did not differ (P = 0.085). Eight of 16 phakic eyes showed progression of cataract, 2 of which underwent cataract extraction. Nine of 18 patients without a history of glaucoma developed ocular hypertension and required glaucoma medication during postinjection follow-up. Trabeculectomy was performed on two eyes with glaucoma. Two other eyes developed epiretinal membranes, one of which underwent vitrectomy. CONCLUSIONS: Intravitreal triamcinolone may be effective in treating macular edema from CRVO and HRVO. Subjects with concurrent diabetes or ischemic central retinal vein were less likely to have visual improvement.     

Intravitreal triamcinolone for cystoid macular edema related to branch retinal vein occlusion

We retrospectively evaluated the effectiveness of intravitreal triamciolone in treating 19 eyes with macular edema related to branch retinal vein occlusion (BRVO). Eyes with nonischemic BRVO respond more favorably than those with ischemic BRVO. A single injection of intravitreal triamcinolone led to elevated intraocular pressure in 3 of 19 eyes (16%). Half of phakic eyes had progression of cataract. Retreatment may be necessary.     

Intravitreal triamcinolone acetonide treatment of macular edema associated with central retinal vein occlusion

PURPOSE: To evaluate treatment of macular edema associated with central retinal vein occlusion (CRVO) using intravitreal triamcinolone acetonide. METHODS: Retrospective review of data for 29 eyes of 29 patients with CRVO and macular edema treated with intravitreal triamcinolone acetonide. Initial visual acuity, intraocular pressure, and history of glaucoma were recorded. Final visual acuity, intraocular pressure, and adverse events were recorded during the treatment period. RESULTS: Twenty-nine eyes were treated with intravitreal injection. The mean follow-up was 348 days. The median initial Early Treatment Diabetic Retinopathy Study visual acuity was 20/250 (median logMAR, 1.1). The median visual acuity 3 months after injection was 20/125 (median logMAR, 0.8). This difference was statistically significant. The median final visual acuity was 20/250 (median logMAR, 1.1). This difference in visual acuity was not statistically significant. Elevated intraocular pressure, excluding that related to neovascularization, occurred in 5 of 22 patients. Subgroup analysis revealed that patients who received multiple injections had better outcomes. CONCLUSION: Intravitreal triamcinolone acetonide may improve vision transiently but does not appear to result in a sustained visual acuity benefit for patients with macular edema associated with CRVO. Repeated injections may be necessary. The risk of glaucoma is significant, and additional study is required to further characterize this and other risks.     

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.     

Intravitreal triamcinolone as primary treatment of cystoid macular edema secondary to branch retinal vein occlusion

PURPOSE: To describe six patients treated with intravitreal triamcinolone (IVT) as primary therapy for cystoid macular edema (CME) secondary to branch retinal vein occlusion (BRVO). METHODS: Retrospective case series. RESULTS: The age of the patients ranged from 53 years to 87 years (mean, 66 years). The time between BRVO and treatment with IVT ranged from 2.0 months to 4.7 months (mean, 3.5 months). Pretreatment visual acuity ranged from 20/40 to 6/200 (mean, 20/166). Length of follow-up ranged from 107 days to 175 days (mean, 149.5 days). Final visual acuity ranged from 20/40 to 3/200 (mean, 20/137). Three of six eyes showed improvement in vision. All three patients who did not have vision improvement were treated with a second injection. At the final follow-up visit, all six eyes had improved vision from baseline. Five (83.3%) of six eyes showed an improvement of > or = 2 lines of vision. One patient had a postoperative rise in intraocular pressure requiring a trabeculectomy. Final visual acuity in the 6 eyes ranged from 20/200 to 20/30 (mean, 20/106). CONCLUSION: IVT may be of potential use in treating CME due to BRVO, as either a primary or an adjunctive treatment modality. A prospective, randomized trial to clarify this role is warranted.     

玻璃体腔注射曲安奈德治疗视网膜静脉阻塞黄斑水肿(英文)

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。     

玻璃体腔注射曲安奈德与Bevacizumab治疗视网膜静脉阻塞性黄斑水肿疗效比较

目的 比较玻璃体腔注射曲安奈德(TA)与抗血管内皮生长因子单克隆抗体(Bevacizumab)治疗视网膜静脉阻塞性黄斑水肿(RVOME)的临床疗效.方法 共116例眼科常规检查以及荧光素眼底血管造影(FFA)和光学相干断层扫描(OCT)检查确诊的RVOME患者的116只眼纳入观察.患者被分成两组进行玻璃体腔注射TA(4mg,0.1ml)或Bevacizumab(1.25mg,0.05ml)治疗.TA组75例,Bevacizumab组41例,两组在术前年龄、病程、最佳矫正视力(BCVA)、中心视网膜厚度(CMT)方面均无显著差异.比较治疗前和治疗后4、8、12周两组间以及各组内部的BCVA、CMT的改变.结果 视力方面,与基线比较,TA组治疗后4周(P=0.000)、8周(P=0.000)、12周(P=0.000)时均有显著提高;Bevacizumab组治疗后4周(P=0.000)、8周(p=0.000)时显著提高,12周时有所回落(P=0.074).CMT方面,与基线比较,TA组治疗后4周(P=0.000)、8周(p=0.000)、12周(P=0.004)时,均有显著降低;Bevacizumab组治疗后4周(P=0.003)、8周(P=0.000)时显著降低,12周(P=0.205)时无显著差异.两组间比较,视力在4周(P=0.985)、8周(P=0.989)、12周(P=0.306)时均无显著差异;CMT在4周(P=0.075)、8周(P=0.453)、12周(P=0.583)时均无显著差异.治疗后眼压明显升高仅见于TA组.结论 玻璃体腔注射TA或bevacizumab治疗RVOME均能明显改善视力,减轻黄斑水肿.此结果还需大样本、多中心的临床随机对照研究.     

Intravitreal triamcinolone acetonide for treatment of persistent macular oedema in branch retinal vein occlusion

BACKGROUND: To evaluate the efficacy of intravitreal triamcinolone acetonide injection on persistent macular oedema in branch retinal vein occlusion that fails to respond to previous laser photocoagulation. MATERIAL AND METHODS: A total of 19 eyes of 19 patients with persistent macular oedema due to branch retinal vein occlusion were treated with 8 mg/0.2 ml of intravitreal triamcinolone acetonide injection. The main outcome measures included best-corrected visual acuity, intraocular pressure, and macular oedema map values of Heidelberg Retinal Tomograph II (HRT II) before and after intravitreal triamcinolone injection. RESULTS: The mean follow-up time was 6.2+/-1.0 months. The mean baseline best-corrected logarithm of minimal angle of resolution (LogMAR) value for visual acuities of the patients before intravitreal triamcinolone injection was 1.01+/-0.16. After treatment, it was 0.55+/-0.22 at the 1-month, 0.56+/-0.22 at 3-month, and 0.62+/-0.22 at the last visits and the differences were statistically significant when compared with baseline values (for each, P<0.001). The mean oedema map values on HRT II significantly decreased by 28.5% at 1-month, 23.8% at 3-month, and 23.8% at the last visit when compared with preinjection values (for each, P<0.001). Intraocular pressure elevation exceeding 21 mmHg was observed in 26.3% of eyes at 1-month, 15.7% at 3-month, and 5.2% at the last visit, but was controlled with topical anti-glaucomatous medications in all eyes. CONCLUSION: Intravitreal triamcinolone acetonide application is a promising approach in the treatment of persistent macular oedema due to branch retinal vein occlusion non-respondent to laser photocoagulation.     

Intravitreal tissue plasminogen activator to treat macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of intravitreal tissue plasminogen activator (tPA) injection for branch retinal vein occlusion (BRVO). DESIGN: Retrospective, interventional case series. METHODS: Seventeen eyes presenting with macular edema caused by BRVO were treated with an intravitreal tPA (Monteplase, 40 k IU) injection. We assessed the visual acuity (VA) and foveal thickness measured with optical coherence tomography. RESULTS: The mean duration of symptoms before surgery was 3.6 +/- 3.8 weeks. The mean logMAR VA significantly improved from 0.603 +/- 0.327 at baseline to 0.388 +/- 0.248 (P < .01) at one month and 0.359 +/- 0.319 (P < .05) at six months. The mean foveal thickness significantly decreased from 738 +/- 156 microm at baseline to 454 +/- 213 microm (P < .001) at one month and 253 +/- 164 microm (P < .001) six months. CONCLUSION: Intravitreal tPA injection may be an effective treatment for resolving macular edema and improving the VA in BRVO.