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。     

玻璃体注射曲安奈德联合视网膜光凝治疗黄斑水肿30眼

目的 观察玻璃体内注射曲安奈德联合多波长氪激光视网膜光凝治疗弥漫性黄斑水肿的疗效和安全性.方法 对符合入选条件的25例(30眼)弥漫性黄斑水肿患者行玻璃体腔内注射曲安奈德,水肿明显减轻或消失者行多波长氪激光视网膜光凝.结果 所有病例中有5眼视力稳定,2眼视力下降,23眼视力有不同程度提高.所有病例荧光素眼底血管造影均显示治疗后弥漫性黄斑水肿渗漏减轻或消失.5眼眼压大于21 mm Hg(1 mm Hg=0.133 kPa).结论玻璃体内注射曲安奈德联合多波长氪激光视网膜光凝治疗糖尿病性视网膜病变及视网膜静脉阻塞引起的弥漫性黄斑水肿不失为一种可取的方法 .     

后Tenon囊下注射曲安奈德联合格栅样光凝治疗视网膜分支静脉阻塞黄斑水肿的临床疗效观察

目的观察后Tenon囊下注射曲安奈德（TA）联合格栅样光凝治疗视网膜分支静脉阻塞（BRVO）黄斑水肿的临床疗效。方法选择我院门诊2009年5月至2011年10月缺血型BRVO黄斑水肿眼48例,随机分为两组,激光格栅样光凝治疗组和后Tenon囊下注射TA联合激光格栅样光凝治疗组,两组均先行激光格栅样光凝治疗黄斑水肿,实验组随后行TA40mg后Tenon囊下注射。观测两组治疗前和治疗后3天、1周、1月、3个月时视力、眼压、荧光素眼底血管造影（FFA）。结果所有患眼视力均有不同程度提高,实验组1周内6例视力提高,1,3月同期两组视力提高比较,有显著差异沪〈0．05）,FFA显示黄斑水肿减轻或消退。2月内暂时性眼压轻度升高6只眼,经局部药物治疗后3个月内均恢复正常。所有患眼未见眼内炎、眼球壁穿孔、眼眶出血等并发症。结论后Tenon囊下注射TA联合黄斑格栅样光凝治疗BRVO黄斑水肿效果明显,恢复快。     

曲安奈德玻璃体腔注射的并发症

曲安奈德（Triamcinolone acetonide TA）作为一种长效皮质类固醇激素已在眼科得到广泛应用，给药方式主要包括结膜下注射、Tenon，s囊下注射和球后注射，但由于治疗部位的有效浓度低、治疗效果不明显使这些给药方式受到一定的限制。近两年来，玻璃体腔注射曲安奈德（Intravitreal Triamcinolone acetonide IVTA）由于局部药物浓度高已得到推广。玻璃体腔注射曲安奈德主要用于治疗各种内眼性、新生血管性、增殖性或水肿性疾病，诸如弥漫性糖尿病黄斑水肿，视网膜静脉阻塞所致黄斑水肿，增殖性糖尿病视网膜病变，增殖性玻璃体视网膜病变，年龄相关性黄斑变性所致视网膜下新生血管，慢性早期结核性低眼压∥慢性葡萄膜炎和白内障术后持续性黄斑囊样水肿。曲安奈德确切的治疗机制虽尚不清楚，但是有几个假说，例如降低局部炎症介质，使钙通道上调，降低血管内皮生长因子的浓度，改善血——网膜屏障的功能。目前国内外已在广泛应用玻璃体腔注射曲安奈德，临床效果也很明显，但与此相关的并发症也有报道。玻璃体腔注射曲安奈德的并发症主要分为两类：手术相关性并发症和激素相关性并发症。     

后Tenon囊下注射曲安奈德治疗黄斑水肿临床观察

目的 评价后Tenon囊下注射曲安奈德(TA)治疗各种疾病导致的黄斑水肿的疗效和安全性.方法 对符合入选条件的黄斑水肿的患者20例22只眼,所有患者于后Tenon囊下注入40mg曲安奈德.随访3个月,对比观察用药前后的视力、眼压、眼底改变以及光相干断层扫描(OCT)测量的黄斑区视网膜厚度变化,并观察并发症的情况.结果 治疗前,患者的平均视力为0.281±0.17,平均黄斑中心凹厚度(OCT测量)为(363.91±128.03)μm.治疗后1周、1个月、3个月,患者的平均视力分别是0.33±0.21、0.37±0.21、0.39±0.23, (P=0.005).黄斑中心凹平均厚度(278.68+108.56)μm、(225.91±68.43)μm、 (221.82±87.59)μm(P=0.000).5只眼(22.7%)视力提高3行,3只眼(13.6%)视力提高2行.随访中3只眼在注药后1～3个月内先后发生黄斑水肿复发,重复注射曲安奈德40mg,除此之外本组未观察到其他与注射相关的并发症.结论 后Tenon囊下注射TA可减轻黄斑水肿,部分患者的视力有一定程度的提高.尚需进一步评价其长期疗效和安全性.     

曲安奈德眼内注射联合格栅样光凝治疗视网膜静脉阻塞黄斑囊样水肿短期疗效观察

目的:观察曲安奈德玻璃体腔注射联合黄斑区格栅样光凝治疗视网膜静脉阻塞黄斑囊样水肿的效果.方法:视网膜静脉阻塞合并黄斑囊样水肿的患者40例40眼,其中治疗组20例20眼给予曲安奈德2mg玻璃体腔注射,lwk后行黄斑区格栅样光凝治疗;另外对照组20例20眼行单纯曲安奈德2mg眼内注射.通过OCT测量黄斑区视网膜的厚度以分析治疗前后黄斑囊样水肿的吸收情况和视力的改善情况.结果:治疗组患者治疗前黄斑区视网膜平均厚度为412.67±133.04μm,治疗后3mo为281.63±59.39μm;对照组治疗前黄斑区视网膜的平均厚度为409.58±131.96μm,治疗后3mo为358.72±116.17μm,治疗后两组患者间黄斑区的视网膜厚度变化差异有统计学意义(t=8.97,P=0.003 ＜0.05).治疗组3mo后有4眼患者黄斑囊样水肿复发,再次行曲安奈德眼内注射;对照组3 mo后有12眼黄斑水肿复发,再次行眼内曲安奈德注射治疗.卡方检验比较两组患者间复发病例,差异有统计学意义(x2=6.50,P=0.022＜0.05).结论:曲安奈德玻璃体腔注射联合黄斑区格栅样光凝治疗静脉阻塞黄斑囊样水肿疗效显著,患者视力有所提高,并且较少复发.     

曲安奈德玻璃体腔注射治疗视网膜静脉阻塞继发黄斑水肿的疗效观察

目的观察玻璃体腔注射曲安奈德（TA）治疗视网膜静脉阻塞（RVO）继发黄斑水肿的疗效。方法对经间接检眼镜、荧光素眼底血管造影（FFA）以及光学相干断层扫描（OCT）检查确诊的RVO继发黄斑水肿患者39例39眼行TA玻璃体腔注射，治疗后随访1年，对比分析术前术后不同时期的视力、眼底、FFA表现，观察OCT显示黄斑水肿高度。结果中央视网膜静脉阻塞（CRVO）24眼（缺血型17眼，非缺血型7眼），分支视网膜静脉阻塞（BRVO）15眼（缺血型7眼，非缺血型8眼）。最终随访视力提高者28眼，比术前降低者5眼，不变者6眼。OCT形态恢复正常者15眼，改善者21眼，无改善者3眼。12眼术后出现一过性眼压升高。结论玻璃体腔注射TA是一种安全有效的治疗视网膜静脉阻塞继发黄斑水肿的方法。     

氩激光联合曲安奈德球后注射治疗黄斑水肿

目的:探讨曲安奈德注射液球后注射治疗黄斑水肿的疗效。方法:选择黄斑水肿病例48例48眼,其中26例为实验组,22例为对照组。两组均先氩绿激光格栅样光凝治疗黄斑水肿后,实验组随后球后注射曲安奈德注射液20mg/0.5mL,对照组不注射。结果:两组患者治疗后视力均有所提高,实验组7d内即有6例提高。1,3mo同期两组视力提高比较,有显著差异(P<0.05);黄斑中心视网膜厚度测量:两组治疗后7d;1mo经OCT测得黄斑中心厚度较治疗前均有明显变薄,治疗后1mo两组降低数值相比有显著差异(P<0.05),3moFFA检查黄斑水肿明显吸收。结论:对于黄斑水肿,氩绿激光联合球后注射曲安奈德治疗效果明显,恢复快。     

早期和晚期激光治疗视网膜分支静脉阻塞的疗效比较

目的:比较早期行氪激光视网膜光凝治疗视网膜分支静脉阻塞和晚期激光治疗的疗效.方法:视网膜分支静脉阻塞患者125例125眼分为早期治疗组68例68眼和晚期治疗组57例57眼,初诊时行视力、眼压、眼底、FFA和OCT检查.早期组在初诊时行氪激光光凝治疗:除出血区行氪红激光和波及黄斑区行氪黄激光,其余行氪绿激光,激光术后给予球后注射曲安奈德40mg.晚期组在初诊时口服沃丽汀、维生素C和安多明等药物,若病变波及黄斑区引起黄斑水肿者行球后注射曲安奈德40mg.1,3,6,12mo行复诊,复诊时行视力、眼压、眼底、FFA和OCT检查.若FFA检查发现晚期组视网膜出现毛细血管无灌注区行氪激光光凝治疗.随访时间为1a.结果:早期组68眼中视力提高49眼(72.1%),视力稳定16眼(23.5%),视力下降3眼(4.4%);晚期组57眼中视力提高35眼(61.4%),视力稳定8眼(14.0%),视力下降14眼(24.6%).FFA和OCT检查发现早期组黄斑水肿消失或减轻的时间比晚期组明显缩短,视网膜出血吸收的时间也比晚期组缩短.早期组中没有1眼发生黄斑囊样变性、黄斑裂孔和玻璃体出血,晚期组中有14眼发生黄斑囊样变性或黄斑裂孔,有9眼发生玻璃体出血导致视力显著下降.结论:早期行氪激光视网膜光凝治疗视网膜分支静脉阻塞的疗效明显优于晚期激光治疗,早期治疗能最大限度保存和提高患者的视力.早期行激光治疗未发现明显的不良反应,是安全有效的方法.     

玻璃体腔注射曲安奈德减轻视网膜静脉阻塞继发的黄斑水肿

目的:评估玻璃体腔内注射曲安奈德(triamcinolone acetonide,TA)治疗视网膜静脉阻塞(retinal vein occlusion,RVO)引起的黄斑水肿的长期安全性与有效性。方法:患者17例17眼出现视网膜静脉阻塞引起的黄斑水肿,接受玻璃体腔内注射2mgTA,随访1a,监测患者视力、黄斑厚度。结果:随访发现,15眼(88%)视力得到明显改善,从术前0.114±0.068增加到术后的0.184±0.094,差异有统计学意义(P<0.05),而中央黄斑区的厚度从术前的514.0±67.4μm减少到术后的442.0±61.5μm,差异有统计学意义(P<0.05)。术后6例患者出现短期眼压升高,并无并发性白内障,玻璃体出血,视网膜脱离以及眼内炎的发生。结论:玻璃体腔内注射TA能长期有效减缓RVO引起的黄斑水肿。     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

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 acetonide for macular oedema owing to retinal vein occlusion

PURPOSE: To assess the long-term safety and efficacy of intravitreal triamcinolone acetonide injection in the management of macular oedema caused by central, hemi-, and branch retinal vein occlusion (CRVO, HRVO, or BRVO). METHODS: This prospective, interventional case series included 13 patients (13 eyes) with retinal vein occlusion and macular oedema. They received an intravitreal injection of 4 mg triamcinolone acetonide. Follow-up was for 1 year with repeat injections where appropriate. Outcome measures were visual acuity and macular thickness measured using ocular coherence tomography (OCT). RESULTS: There were four patients with CRVO, one with HRVO, and eight with BRVO (13 eyes). Mean duration of symptoms before intravitreal triamcinolone acetonide injection was 6.8 months (SD 4.5 months). Eight eyes (62%) responded well with improved visual acuity and macular thickness 1-3 months postinjection. All eight eyes developed recurrent macular oedema and five received repeat injections. Three patients declined a second injection. No improvement in visual acuity or OCT macular thickness was seen after the second injection with visual acuity returning to baseline levels at 1-year follow-up. Three eyes (23%) showed no response to the initial injection (no improvement in macular thickness or visual acuity). Seven patients (54%) had a rise in intraocular pressure with six (46%) requiring treatment. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide is effective as a short-term treatment of macular oedema owing to retinal vein occlusion, improving both visual acuity and macular thickness. However, this effectiveness is not maintained after 1 year despite repeat injections.     

Intraocular triamcinolone acetonide for pseudophakic cystoid macular edema: optical coherence tomography and multifocal electroretinography study

PURPOSE: To evaluate pseudophakic cystoid macular edema (CME) by optical coherence tomography (OCT) and multifocal electroretinography (mf-ERG) and determine the efficacy of intravitreal triamcinolone acetonide injections. METHODS: In this nonrandomized retrospective study, 14 eyes of 14 patients with persistent pseudophakic CME were treated with triamcinolone acetonide injection and were followed up for 1 year. All patients underwent complete ophthalmologic examination including determination of best-corrected visual acuity, slit-lamp examination, tonometry, and funduscopy. Results of OCT and mf-ERG were also recorded before and after the injection. RESULTS: Visual acuity and mf-ERG values increased in all patients after intravitreal triamcinolone acetonide injections. OCT showed improvement of the retinal thickness in the macular area. Temporary increase of intraocular pressure was controlled with topical use of antiglaucoma drops. CONCLUSION: Intravitreal triamcinolone acetonide injection is a promising therapeutic tool for chronic pseudophakic edema resistant to other medical treatment. However, further study is needed to assess the treatment's long-term efficacy, its safety, and the need for retreatment.     

球后注射曲安奈德联合激光光凝治疗糖尿病弥漫性黄斑水肿的临床观察

目的观察球后注射曲安奈德(TA)联合激光光凝治疗糖尿病性弥漫性黄斑水肿的疗效。方法34例48眼经眼底检查、荧光素眼底血管造影(FFA)检查确诊的糖尿病性弥漫性黄斑水肿患者24眼球后注射TA联合激光光凝,24眼单纯激光光凝,随访6m,观察治疗前后患眼视力、眼底情况、眼压以及眼底荧光素血管造影的变化。结果联合组视力提高15眼(62.5%),视力不变5眼(20.8%),视力下降4眼(16.7%)。水肿减轻20眼(83.3%),水肿未退4眼(16.7%)。单纯光凝组视力提高5眼(20.8%),视力不变12眼(50%),视力下降7眼(29.2%)。水肿减轻9眼(37.5%),水肿未退15眼(62.5%)。结论光凝治疗糖尿病弥漫性黄斑水肿时联合球后注射曲安奈德球可促进水肿吸收和视力改善,且安全、方便。     

曲安奈德球后注射联合激光光凝治疗视网膜静脉阻塞继发黄斑水肿

目的评价球后注射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的疗效。方法视网膜静脉阻塞继发黄斑水肿46例（46眼）中,23眼进行单纯激光治疗,另23眼球后注射曲安奈德联合激光光凝治疗。随访3～6个月,观察治疗前后视力、眼底、眼压及荧光素眼底血管造影的变化。结果经治疗,药物联合激光组视力提高14眼（60．9％）,视力不变为5眼（21．7％）,视力下降4眼（17．4％）,水肿减轻19眼（82．6％）,水肿未退4眼（17．4％）。单纯光凝组视力提高5眼（21．7％）,视力不变13眼（57．6％）,视力下降5眼（21．7％）,水肿减轻8眼（34．8％）,水肿未退15眼（65．2％）。视力提高和水肿消退情况,联合组均优于单纯激光组（P〈0．05）。所有患者均未出现球后出血、眼内炎、白内障或视网膜脱离等并发症。结论激光光凝治疗视网膜静脉阻塞继发黄斑水肿时联合球后注射曲安奈德可促进水肿吸收和视力改善。     

Intravitreal triamcinolone acetonide for the management of papillophlebitis and associated macular edema

Background To investigate the efficacy of intravitreal injection of triamcinolone acetonide in the management of papillophlebitis and associated cystoid macular edema. Methods This study was a retrospective medical records review of four eyes of four patients (three males and one female) who had approximately 2-4 months history of papillophlebitis and associated persistent cystoid macular edema. These patients were treated with a single intravitreal injection of 4 mg triamcinolone acetonide. Mean follow-up time was 15 +/- 4 months. The outcome measures included best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness by optical coherence tomography (OCT). Results The BCVA ranged from 20/100 to 20/60 pre-operation. The mean gain in BCVA was 7 +/- 1 Snellen lines. All eyes had BCVA of 20/20 at the last visit. The mean baseline central retinal thickness as measured by OCT was 529 +/- 53 mum. The mean central retinal thickness by OCT was 235 +/- 15 mum at 1-week follow-up examination. At the last visit the mean central retinal thickness by OCT was 161 +/- 7 mum. One patient experienced an increase in IOP after the first injection and another patient had IOP elevation after the second injection. Both were well controlled with single topical anti-glaucoma medication. Conclusion Intravitreal injection of triamcinolone acetonide appears to be an effective treatment for patients with papillophlebitis and associated cystoid macular edema.     

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:评价玻璃体腔注射曲安奈德治疗视网膜静脉阻塞合并黄斑水肿的疗效及并发症。方法:患者30例30眼玻璃体腔注射曲安奈德4mg治疗视网膜静脉阻塞合并黄斑水肿,观察治疗前、后的最佳矫正视力、眼压、裂隙灯显微镜检查、眼底荧光血管造影和光学相干断层扫描的变化,采用SPSS 12.0软件进行统计学分析。结果:所有患者手术后视力均显著提高,平均黄斑中心凹厚度(CMT)显著减少。病程、年龄、注射前CMT及视网膜静脉阻塞的类型和视力预后无相关性,注射前视力与注射后末次视力呈正相关。结论:玻璃体腔注射曲安奈德治疗视网膜静脉阻塞合并黄斑水肿简单、安全、易操作,短期内可以迅速减轻黄斑水肿,最终的视力预后取决于治疗前的视力,部分患者在注射后3 ～6mo可能复发。