Arteriovenous crossing sheathotomy versus intravitreal triamcinolone acetonide injection for treatment of macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the functional and anatomical outcomes of arteriovenous (AV) sheathotomy and intravitreal triamcinolone acetonide (IVTA) injection in the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Forty eyes of 40 patients with macular edema secondary to BRVO were randomized into two treatment groups. A total of 20 patients received AV sheathotomy (sheathotomy group), and the second group of 20 patients was treated with IVTA (IVTA group). Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) score, total macular volume measured, and foveal thickness by 3rd generation optical coherence tomography (OCT3) were evaluated as main outcome measurements. RESULTS: The average changes in ETDRS scores, total macular volumes, and foveal thicknesses compared to baseline values, were significant 3 months and 6 months after treatment in both groups (P < 0.05, paired t-test), but only the IVTA group showed significant improvements 1 month after treatment. The between-group differences in average ETDRS score, total macular volume, and foveal thickness changes were significantly better at 1 month after treatment in the ITVA group (P = 0.026, P < 0.001, P = 0.001, respectively, Student's t-test), at which time IVTA patients had better vision and anatomical outcomes than did those in the sheathotomy group. CONCLUSIONS: After either AV sheathotomy or IVTA treatment, patients with macular edema secondary to BRVO showed similar functional and anatomical outcomes 6 months later. When the cost and the risks of vitreoretinal surgery are considered, IVTA treatment may be a better treatment option, as the drug yields better short-term outcomes.     

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Background  To determine the efficacy of combined intravitreal triamcinolone (TA) injection and laser photocoagulation in persistent macular edema after branch retinal vein occlusion (BRVO). Methods  Follow-up analysis of a case series of 24 patients with macular edema after BRVO (15 of 24 non-ischaemic, 9 of 24 ischaemic). Patients received an intravitreal injection of 4 mg TA followed by laser photocoagulation within the previously edematous area, applied in one or two sessions. Standardized clinical examinations included best corrected visual acuity testing, anterior and posterior segment biomicroscopy, intraocular pressure, and optical coherence tomography (OCT). Fluorescein angiography was performed before treatment and 3 and 6 months later. Results  Median visual acuity improved significantly from 0.58 logMAR (95%-confidence interval (KI): 0.54 – 0.75, decimal 0.27) at baseline to 0.41 logMAR (KI: 0.37 – 0.64, decimal 0.39) at 1 month (p = 0.001), 0.33 logMAR (KI: 0.32 – 0.62, decimal 0.47) at 3 months (p = 0.002), and 0.41 logMAR (KI: 0.33 – 0.67, decimal 0.39) at 6 months (p = 0.016). A gain of one or more logarithmic lines was evaluated in 16/24 eyes (67 %) and a gain of 3 lines or more in 8/24 eyes (33 %) at 6 months. Three eyes had lost more than 1 line during the follow-up period. Median change of visual acuity at 6 months was +2.0 lines (KI: 0.2 – 2.4). Median central foveal thickness (OCT-CFT) was 423 μm (KI: 378 – 456, n = 24) at baseline and decreased to 270 μm (KI: 249 – 311, n = 24) at 1 month (p < 0.0001), 265 μm (KI: 254 – 344, n = 24) at 3 months (p < 0.0001), and 266 μm (KI: 259 – 365, n = 18) at 6 months (p = 0.001). Conclusions  Macular edema after BRVO can effectively be treated by a combination of intravitreal TA injection and subsequent laser photocoagulation. During a 6-month follow-up this combination treatment resulted in a significant reduction of central foveal thickness and improvement of visual acuity.     

曲安奈德玻璃体腔注射治疗视网膜分支静脉阻塞继发黄斑水肿

目的:观察玻璃体腔注射曲安奈德(tviamcinolone ace-tonide,TA)治疗视网膜分支静脉阻塞(branch retinal vein occusion,BRVO)继发黄斑水肿的疗效。方法:经眼底检查、荧光眼底血管造影(FFA)、光学相干断层扫描(OCT)检查确诊的BRVO继发黄斑水肿22例(22眼)行玻璃体腔曲安奈德注射,治疗后随访(4.2±0.4)mo,对比治疗前及治疗后1,3mo视力、眼压、眼底、FFA表现、OCT所显示黄斑水肿高度以及黄斑中心凹阈值。结果:治疗的22眼中19眼(82%)视力明显提高,3眼(14%)视力不变,治疗前平均视力0.10±0.06,治疗后1,3mo平均视力分别为0.25±0.12、0.28±0.13,黄斑中心凹厚度(OCT)治疗前平均厚度(519.0±137.5)μm,治疗后1,3mo平均厚度分别为(256.4±68.3)μm、(239.4±52.2)μm,黄斑中心凹阈值(dB):治疗前(18.8±4.2)dB,治疗后1,3mo分别为(24.0±6.0)dB、(24.6±5.2)dB,治疗前后比较差异有统计学意义(P<0.01)。22眼中有6眼(27%)治疗后暂时性眼压升高,经局部抗青光眼药物治疗后恢复正常。5例(23%)患者2次注药。结论:玻璃体腔注射TA在短期内可有效改善BRVO继发黄斑水肿,但也要注意对原发病治疗。     

Prognostic factors for visual outcome after intravitreal bevacizumab for macular edema due to branch retinal vein occlusion

PURPOSE: To evaluate the prognostic factors for visual outcome after intravitreal bevacizumab injection to treat macular edema due to branch retinal vein occlusion (BRVO). METHODS: Fifty eyes of 50 consecutive patients treated with intravitreal bevacizumab for macular edema due to BRVO with minimum follow-up of 3 months were retrospectively reviewed. Patients were categorized into two groups according to the final visual acuity. Group 1 consisted of eyes with 5 or more ETDRS letters gain, and group 2 consisted of eyes with less than 5 letters improvement or which had worsened at last follow-up visit. Comparative clinical and fluorescein angiographic characteristics were analyzed between the two groups. RESULTS: Of 50 eyes, 28 (56%) had improved vision after intravitreal bevacizumab injections and were categorized as group 1; 22 eyes (44%) were categorized as group 2. The number of early VA gainers, who showed visual improvement at 1 month after bevacizumab injection, was significantly higher in group 1 (P < 0.001, chi-square test). The early gainers tend to maintain significantly better visual outcome until last follow-up. The number of eyes with angiographically documented macular ischemia was significantly higher in group 2 (P < 0.001). In group 2, the decrease in central macular thickness was not accompanied by visual acuity improvement. CONCLUSION: Preoperative presence of macular ischemia can be useful in predicting the outcome of visual acuity after intravitreal bevacizumab for macular edema due to BRVO. The early gainers who favorably responded to the initial intravitreal bevacizumab injection are most likely to benefit from the bevacizumab treatment.     

Retinal sensitivity improvement after intravitreal triamcinolone acetonide injection for macular edema secondary to branch retinal vein occlusion

Purpose:

To evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on retinal sensitivity in cases of macular edema(ME) secondary to branch retinal vein occlusion (BRVO).

Materials and Methods:

Total of 14 eyes of 14 cases of BRVO were included in this prospective study. In each eye, at baseline and 1, 3, and 6 months after IVTA injection, logMAR visual acuity, central 4° retinal sensitivity by MP-1 microperimetry, and optical coherence tomography foveal thickness were assessed.

Results:

Cases ages ranged from 60 to 79 years (mean 68 ± 8 years). At 1, 3, and 6 months, the logMAR visual acuity had increased from 0.71 ± 0.21 to 0.42 ± 0.21, 0.46 ± 0.30, and 0.46 ± 0.27; the mean foveal thickness had decreased from 540 ± 88 μm to 254 ± 51 μm, 288 ± 84 μm, and 280 ± 91 μm; and the mean retinal sensitivity had increased from 4.7 ± 2.5 dB to 7.9 ± 2.7 dB, 8.2 ± 3.6 dB, and 8.3 ± 4.6 dB, respectively.

Conclusion:

In eyes with ME secondary to BRVO, IVTA injections result in a significant increase in not only the visual acuity but also the central 4° retinal sensitivity in 6 months follow-up.     

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。     

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。     

Comparison of intravitreal injection of conbercept and triamcinolone acetonide for macular edema secondary to branch retinal vein occlusion

AIM: To compare the safety and efficacy of the intravitreal injection of conbercept (IVC) and triamcinolone acetonide (IVTA) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: A prospective, randomized clinical study. Patients with ME secondary to BRVO were randomly assigned to either IVC group or IVTA groups at a ratio of 2:1 and a 12-month follow-up was performed. The efficacy outcome measures included the mean changes and differences in best corrected visual acuity (BCVA) and the central retinal thickness (CRT). The safety profiles and the mean retreatment intervals were also compared. RESULTS: There was no statistically significant difference of baseline between the two groups. At 12mo, the BCVA letters improved by 27.31±18.36 in the IVC group, and 13.53±11.37 in the IVTA group (P=0.0004). CRT reduction was 253.33±163.69 and 150.23±134.32 μm, respectively (P=0.0034). The mean BCVA in the IVC group was superior to that of the IVTA group for months 6-12 (P?0.01). The mean CRT at 9 and 12mo were thinner in the IVC group compared to the IVTA group (P?0.01). The mean retreatment interval in the IVC group was longer than that in the IVTA group (97.40±36.27d vs 68.71±36.38d, P=0.0030). One eye in the IVC group and seven eyes in the IVTA group developed elevated IOP (P=0.0012). The proportion of eyes with cataract new-onset or progression were 19.44% in the IVC group and 64.71% in the IVTA group (P=0.0012). CONCLUSION: IVC could maintain or improve BCVA and reduce CRT for a longer time and have longer retreatment interval than IVTA. In addition, patients treated with IVTA are more susceptible to IOP elevation and cataract progression.     

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。     

TA联合激光治疗视网膜静脉阻塞黄斑水肿的临床观察

目的:观察玻璃体腔内注射曲安奈德联合激光光凝治疗视网膜静脉阻塞引起的黄斑水肿的有效性和安全性。方法:患者38例38眼经眼底镜检查、眼底荧光素血管造影(fundus fluorescein angiography,FFA)及光学相干断层扫描(optical coherence tomography,OCT)检查明确诊断的视网膜静脉阻塞引起的黄斑水肿,玻璃体腔内注入曲安奈德4mg(0.1mL),术后1～2mo时行视网膜激光光凝,随访3～9mo,观察视力、眼压、眼底情况及视网膜厚度变化。结果:视力提高36眼,视力无变化2眼。视力<0.1者3眼,0.1～0.3者11眼,0.3～0.5者17眼,>0.5者7眼。4例患者眼压不同程度升高,予以局部降眼压药物治疗后,术后2～5mo眼压恢复正常,未发生1例视网膜毒性反应。结论:曲安奈德联合激光可以安全、有效治疗视网膜静脉阻塞引起的黄斑水肿,提高患者视功能。     

One-year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion

Background  To investigate the long-term effectiveness of intravitreal bevacizumab treatment in eyes with perfused macular edema due to branch retinal vein occlusion (BRVO). Methods  In this prospective interventional case series, 23 consecutive, previously untreated eyes with perfused macular edema were treated with intravitreal bevacizumab (1.25 mg) injections and followed for 1 year. The main outcome measures were visual acuity (VA) and central retinal thickness (CRT). In addition, VA data were adapted to the non-logarithmic VA charts used in the previously published grid laser photocoagulation BRVO Study. Results  The median VA gained 3.0 lines from baseline at 48 weeks. This was accompanied by a significant decrease of 39% of the median CRT. The mean number of re-injections was 1.6 during the first 6 months of follow-up and only 0.8 during the subsequent 6 months. In 65% of the cases, adapted VA data showed a gain of 1 or more lines and no eye lost more than 1 line. Conclusions  Repetitive intravitreal bevacizumab injections result in a significant long-term improvement of VA and CRT. The number of re-injections necessary to maintain this effect declined over time. However, the treatment seems to be only slightly better than grid laser photocoagulation. Gesine B Jaissle, Martin Leitritz: These authors contributed equally to the work. The study has been supported by the German Ophthalmological Society (DOG). The authors have no financial disclosures. The authors declare no conflicts of interest. The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if requested.     

球后注射曲安奈德治疗视网膜静脉阻塞继发黄斑水肿

目的 观察球后注射曲安奈德(TA)治疗不同类型视网膜静脉阻塞(RVO)所致黄斑水肿的临床疗效.设计回顾性病例系列.研究对象不同类型RVO继发黄斑水肿的患者21例21眼.方法患者均经球后注射TA 40 mg,随访观察不同类型、不同病程RVO致黄斑水肿治疗前后的视力、眼压、荧光素眼底血管造影(FFA)和相干光断层扫描(OCT)检测黄斑水肿的变化情况.随访6～11个月.主要指标视力、黄斑中心凹平均厚度.结果到最后一次随访时,视力提高16眼(76.2%),视力不变5眼(23.8%).治疗前及最后一次随访时黄斑中心凹平均厚度(617.23±185.58)μm、(287.55±121.70)μm(P=0.000).治疗后CRVO组与BRVO组之间、缺血型组与非缺血型组之间,无论是视力还是黄斑中心凹平均厚度的变化的比较,差异均无明显统计学意义(P>0.05);病程≤3个月以及3～6个月的患者治疗前后的视力差异有统计学意义(P值分别为0.011,0.01),病程≥6个月的患者治疗前后的视力差异无明显统计学意义(P=0.583).FFA显示治疗后黄斑区荧光素渗漏明显减轻.所有患者随访期间眼压均≤21 mmHg.8例患者治疗后2～6个月黄斑水肿复发.结论 球后注射TA可有效治疗RVO引起的黄斑水肿,操作简便且安全性高,早期治疗效果好.     

Hemodynamic response to intravitreal triamcinolone in eyes with macular edema

Purpose To assess ocular hemodynamic response to intravitreal triamcinolone in patients with macular edema due to diabetes or retinal vein occlusion. Methods Forty-three patients that were injected by intravitreal triamcinolone acetonide (0.1 cc 4 mg) for unilateral macular edema due to diabetes mellitus (n = 17) and occlusion of retinal vein (n = 26) underwent ocular hemodynamic evaluation by color Doppler imaging (CDI) before and one, two and three months after injection. Non-injected fellow eyes as well as 16 healthy volunteers were also evaluated. Results In patients with diabetic macular edema, there was no hemodynamic difference between eyes to be injected and non-injected at baseline (P > 0.23). Compared to controls, a significant difference existed in the ophthalmic artery resistant index (P = 0.001) and end-diastolic velocity (P < 0.001) in diabetics. At one month, compared to fellow eyes, change in end diastolic velocity from baseline in treated eyes was significantly decreased in posterior ciliary arteries (0.68 ± 0.34 cm/s [mean ± SEM] vs. −1.04 ± 0.81 cm/s, P = 0.012). Throughout the study period, no significant alteration from baseline in the resistant index of any artery was noted in treated diabetic eyes (P > 0.05). In eyes with retinal vein occlusion, baseline CDI evaluation demonstrated reduced posterior ciliary arteries systolic flow velocity compared to fellow and control eyes (13.24 ± 1.04 cm/s, 16.37 ± 0.76 cm/s and 14.33 ± 1.41 cm/s, respectively, P = 0.007). Increased peak systolic velocity in the posterior ciliary arteries at one week (P = 0.02), one month (P = 0.005) and two months (P = 0.04), and increase in central retinal artery resistant index at one month was noted (P = 0.05). Conclusion Intravitreal triamcinolone temporarily changed central retinal artery blood flow and posterior ciliary arteries' peak systolic blood velocity in eyes with retinal vein occlusion whilst no response of blood flow to triamcinolone injection but only transiently altered end diastolic blood velocity in posterior ciliary arteries was observed in diabetic eyes. This study was presented in part at the Mediterranean Retina II Meeting, Antalya, Turkey, June 2006.     

去炎松玻璃体内注射治疗视网膜中央静脉阻塞引起的黄斑水肿37例

目的:评估去炎松玻璃体内注射治疗视网膜中央静脉阻塞造成的黄斑水肿效果。方法:中央视网膜静脉阻塞(CRVO)并发黄斑水肿患者37例(37眼)接受玻璃体腔注射去炎松(40g/L,0.1mL,1～3次)治疗。非缺血性CRVO33眼,缺血性CRVO4眼,注射1次20眼,注射2次15眼,注射3次2眼,平均随访时间9(3～27)mo。患者从症状出现至一次注射药物平均时隔时间为2.7(0.3～9)mo。注射前后均进行最佳矫正视力、眼压、裂隙灯显微镜、荧光素眼底血管造影(FFA)和中央黄斑厚度光相干断层扫描(OCT)检查。结果:治疗前平均视力为0.08(0.01～0.4)。注射后1～3mo,最佳矫正视力提高25眼,无变化3眼,视力下降9眼,在视力提高患眼中,视力提高3行以上12眼,视力提高2行10眼,提高1行3眼。此后,部分视力下降和视力未提高患者,进行2次或3次注射,最终随诊时视力提高24眼,视力无变化3眼,视力下降10眼,在视力提高的患眼中,视力提高3行以上8眼,视力提高2行10眼,提高1行6眼,整个治疗前后平均视力增加2～3行。治疗后1～3mo时,间接眼底镜检查黄斑水肿完全消退16眼,水肿明显减轻19眼,水肿加重2眼。最终随诊时,间接眼底镜检查黄斑水肿完全消退19眼,减轻17眼,加重1眼。15眼在注射药物后1wk～6mo期间先后出现不同程度的高眼压达35.4(25.1～40.1)mmHg(1mmHg=0.133kPa),13眼进行降眼压治疗,其中4眼接受抗青光眼手术。在32只晶状体眼中,出现了晶状体后囊膜下混浊的并发性白内障9眼,进行白内障摘除4眼。OCT检查发现玻璃体腔注射药物治疗后黄斑厚度减少,中央黄斑平均厚度减少至注射前厚度的46%。4眼没有视力的提高。结论:玻璃体腔内注射去炎松是一种治疗视网膜中央静脉阻塞引起黄斑水肿的有效方法。对于缺血性中央视网膜静脉阻塞患者视力不会提高。     

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。     

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。     

不同剂量曲安奈德玻璃体腔注射治疗视网膜静脉阻塞性黄斑水肿

目的：比较不同剂量曲安奈德(triamcinolone acetonide,TA)玻璃体腔注射治疗视网膜静脉阻塞性黄斑水肿的临床疗效和相关并发症,探讨有效安全的注射剂量。

方法：回顾性研究我院2015-01/2017-05收治的视网膜静脉阻塞性黄斑水肿患者62例62眼,根据注射剂量不同,分为1mg组、2mg组和4mg组,其中1mg组18例,2mg组22例,4mg组22例。分别予玻璃体腔注射曲安奈德1mg/0.025mL,2mg/0.05mL,4mg/0.1mL。于注射后1、3、6mo三个时间点进行随访,检查并比较三组患眼的最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心区视网膜厚度(central macular thickness,CMT)、眼压及并发症发生情况。

结果：三组患者注射前年龄、性别、病程、BCVA、CMT、眼压等方面比较,差异均无统计学意义(P>0.05)。1mg IVTA组在注射后1、3mo时,BCVA和CMT较治疗前均有改善(P<0.05)。2mg IVTA组、4mg IVTA组BCVA和CMT在注射后1、3、6mo时均优于治疗前(P<0.05)。注射后3mo和6mo时,2mg IVTA组和4mg IVTA组间BCVA和CMT比较,差异无统计学意义(P>0.05),都优于1mg IVTA组(P<0.05)。 2mg IVTA组和4mg IVTA组分别有2例、6例患者发生眼压升高(≥22mmHg),给予β-受体阻滞剂降眼压处理后,6mo随访期末除4mg IVTA组仍有1例需药物降压治疗外,其余均恢复正常(≤21mmHg)。

结论：2mg曲安奈德可能是玻璃体腔内注射治疗视网膜静脉阻塞性黄斑水肿比较合适的剂量。     

Lucentis联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞黄斑水肿的临床观察

目的 观察玻璃体腔注射雷珠单抗(Lucentis)联合黄斑区格栅样光凝治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿的疗效.方法 随机将确诊BRVO引起黄斑水肿的25例(25只眼),分为玻璃体腔注射Lucentis+格栅样光凝组(联合组)和单纯格栅样光凝组(光凝组).比较两组治疗后4、12、24周的最佳矫正视力、黄斑中心视网膜厚度(CMT)值以及有无并发症发生情况.结果 联合组疗效明显,视网膜厚度降低明显,视力提高快,在4、12、24周观察CMT值分别为:456.53±75.26、326.43±57.48、298.25±65.58.视力及CMT值均与治疗前比较有显著性差异(P＜0.05).激光组治疗后4周视力提高不明显,与治疗前比较无显著性差异(P=0.653);治疗后12周和24周视力逐步提高,但与联合组比较无显著性差异(P=0.462,0.342).视网膜厚度降低,在4、12、24周观查CMT值分别为:(609.81±64.26) μm、(536.06±56.89) μm、(468.31 ±48.8) μm.结论 玻璃体腔注射雷珠单抗(Lucentis)联合黄斑区格栅样光凝治疗可有效促进BRVO继发黄斑水肿的吸收,提高患者视力.     

Short-term efficacy of intravitreal triamcinolone acetonide for macular edema secondary to retinal vein occlusion that is refractory to intravitreal bevacizumab

Aims:

To evaluate the 1-month efficacy of intravitreal triamcinolone acetonide (TA) in treating macular edema secondary to retinal vein occlusion (RVO) that was refractory to intravitreal bevacizumab.

Materials and Methods:

This retrospective, observational study included 23 eyes from 23 patients with macular edema secondary to RVO. Macular edema that did not respond to two or more consecutive intravitreal bevacizumab injections was treated with intravitreal TA. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared before and one month after TA injection.

Results:

Fifteen eyes were diagnosed with central RVO, and eight eyes were diagnosed with branch RVO. All patients were previously treated with 2.4 ± 0.6 intravitreal bevacizumab injections. The TA injection was performed, on average, 5.8 ± 1.4 weeks after the last bevacizumab injection. The CFT before TA injection was 516.6 ± 112.4 μm and significantly decreased to 402.3 ± 159.7 μm after TA therapy (P < 0.001). The logarithm of the minimal angle of resolution BCVA was 0.72 ± 0.34 before TA therapy and was not significantly improved by the treatment (0.67 ± 0.35, P = 0.119), despite a decrease in CFT. However, seven eyes (30.4%) had a BCVA gain of one or more lines.

Conclusions:

Intravitreal TA therapy was beneficial in some patients with macular edema secondary to RVO that was refractory to intravitreal bevacizumab therapy. This study suggests that intravitreal TA should be considered as a treatment option for refractory macular edema.     

视网膜分支静脉阻塞致黄斑水肿玻璃体腔注射Avastin疗效分析

目的 评估视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)继发黄斑水肿时浆液性视网膜神经上皮脱离(serous retinal detachment,SRD)与玻璃体腔注射Avastin疗效之间的关系.方法 临床病例系列研究.回顾性分析2012年6月至2013年9月在北京大学眼科中心行玻璃体腔注射1.25mg (0.05ml) Avastin治疗BRVO继发黄斑水肿患者59例(59只眼).治疗前及治疗后1、3个月进行最佳矫正视力(BCVA)、眼压、裂隙灯、间接检眼镜检查和彩色眼底照相、光学相干断层扫描(OCT)检查;治疗前及治疗后3月行荧光素眼底血管造影(FFA)检查.根据OCT图像有无SRD,将患者分为SRD(+)组与SRD(-)组.结果 SRD(+)组22例(37.29％,22/59)患者,平均年龄低于SRD(-)组差异有统计学意义(P＜0.05),术前黄斑中心区厚度(central subfield macularthickness,CSMT)明显＞SRD(-)组差异有统计学意义(P＜0.01).玻璃体腔注射Avastin后1、3个月,SRD(+)组CSMT的改善幅度明显＞SRD(-)组差异有统计学意义(P＜0.01);玻璃体腔注射Avastin后3个月,SRD(+)组BCVA的提高幅度亦大于SRD(-)组差异有统计学意义(P＜0.05).结论 玻璃体腔注射Avastin治疗BRVO继发黄斑水肿合并SRD的患者CSMT及BCVA改善幅度更大,效果明显.