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疗效观察

目的 观察曲安奈德（TA）球后注射联合格栅样光凝（MLG）治疗糖尿病性弥漫性黄斑水肿（DME）的疗效.方法 以50眼糖尿病性DME为研究对象,30眼给予球后注射TA联合MLG,20眼给予单纯MLG,治疗6个月内,观察患眼视力、黄斑水肿以及黄斑中心凹视网膜厚度.结果 TA联合MLG组患者视力提高21眼,视力不变6眼,视力下降3眼;黄斑中心凹区视网膜厚度治疗前为（598.62±198.58） μm,治疗6个月后（307.51±101.21） μm.MLG组视力提高2眼,视力不变10眼,视力下降8眼;黄斑中心凹区视网膜厚度治疗前为（574.73±187.12） μm,治疗6个月后（369.12±112.20） μm.两治疗组间治疗后有统计学差异.结论 TA球后注射联合MLG治疗糖尿病DME可改善视力、促进黄斑水肿吸收.     

曲安奈德治疗重度糖尿病黄斑水肿的临床观察

目的研究玻璃体腔内注射曲安奈德(TA)治疗重度糖尿病黄斑水肿的有效性。方法对36例(42眼)重度糖尿病黄斑水肿的患者,行玻璃体腔内注射TA(进口)(4mg/0.1ml)的治疗方法。观察治疗前后的四个指标:最佳矫正视力、眼压、眼底荧光血管造影(FFA)、OCT检测黄斑中心凹厚度。随访时间6～12个月(平均9个月)。结果本组病例36例(42眼),年龄45～70岁(平均57岁),FFA检查治疗前黄斑荧光渗漏明显,治疗后渗漏明显减轻;OCT检测黄斑中心凹厚度,治疗前平均(579.5±65)μm,治疗随访6个月后平均(279±78)μm,差异有统计学意义(P<0.05);最佳矫正视力范围治疗前为0.01～0.2,平均0.1,治疗后为0.2～0.4,平均0.3,差异有统计学意义(P>0.05);所有患者眼压都有升高,升高值8.0～20.0mmHg(平均14.0mmHg),7例(7眼)超过正常眼压范围,经治疗,眼压控制,没有严重并发症发生。结论玻璃体腔注射TA是治疗重度糖尿病黄斑水肿的有效方法,患者的视力有轻度提高,治疗后患者FFA,黄斑区荧光素渗漏明显减轻,OCT检查,证实黄斑厚度明显减小。     

糖尿病黄斑水肿应用玻璃体内注射雷珠单抗、曲安奈德的疗效分析

目的 比较玻璃体内注射雷珠单抗、曲安奈德在糖尿病黄斑水肿中的临床疗效.方法 收集本院2014年10月至2015年10月入院的80例糖尿病黄斑水肿患者,随机分为两组,雷珠单抗组患者给予雷珠单抗治疗,曲安奈德组患者给予曲安奈德治疗,比较两组患者治疗前后最佳矫正视力、RNV渗透面积、黄斑区中心视网膜厚度、眼压与并发症等.结果 雷珠单抗组患者BCVA为(0.556±0.155),显著高于曲安奈德组的(0.409±0.143);RNV渗透面积为(5.405±3.274),显著低于曲安奈德组的(8.332±4.058);雷珠单抗组患者CMT为(289.231±64.040) μm,显著低于曲安奈德组的(370.127±88.172)μm;雷珠单抗组患者治疗后眼压为(15.157±2.351) mmHg,显著低于曲安奈德组(17.264±3.197)mmHg;两组比较,t=4.4897、3.550、4.695、3.358,差异有统计学意义(P＜0.01).结论 玻璃体内注射雷珠单抗在糖尿病黄斑水肿中的临床疗效更为显著,安全性较高,具有借鉴性.     

Treatment of diabetic macular edema with sustained-release glucocorticoids: intravitreal triamcinolone acetonide,dexamethasone implant,and fluocinolone acetonide implant

Introduction: Diabetic macular edema (DME) can be treated with intravitreal glucocorticoids, particularly triamcinolone acetonide, dexamethasone (DEX), and fluocinolone acetonide (FA).

Areas covered: The pathophysiology of DME includes multiple growth factors such as VEGF and also inflammatory mediators. Glucocorticoids act on DME through multiple pathways, and current research into their efficacy, safety, and therapeutic potential when administered intravitreally is discussed.

Conclusion: The intravitreal route of administration minimizes systemic side effects of glucocorticoids. Furthermore, sustained-release low-dose delivery via the DEX implant or the FA implant will limit frequent intravitreal injection and possibly some cost associated with intravitreal anti-VEGF therapy. In addition, the durable action of these treatments facilitates combination therapy. Patients can receive these implants as foundational therapy, and then receive additional treatment with laser or intravitreal anti-VEGF agents as combination therapy, which may conceivably provide some synergistic benefit. While the FA implant lasts much longer than the DEX implant, potentially decreasing the visit and treatment burden on patients and their families, the FA implant appears to have a greater risk of inducing ocular hypertension and cataract. However, these modalities have not been directly compared in a clinical trial and there is insufficient evidence to draw more elaborate conclusions.     

玻璃体内注射雷珠单抗与曲安奈德治疗视网膜静脉阻塞继发黄斑囊样水肿的疗效比较

目的：比较玻璃体内注射雷珠单抗与曲安奈德治疗视网膜静脉阻塞（ retinal vein occlusion ,RVO）继发黄斑囊样水肿（ cystoidmacular edema ,CME）的疗效及安全性。方法97例RVO继发CME患者按治疗方法分为雷珠单抗组（n＝47）和曲安奈德组（n＝50）。雷珠单抗组给予玻璃体内注射雷珠单抗0．5 mg（0．05 ml）;曲安奈德组给予玻璃体内注射雷珠单抗4．0 mg（0．1 ml）。治疗后随访6个月,比较2组最佳矫正视力（best corrected visual acuity,BC－VA）、黄斑中心凹厚度（ central macular thickness ,CMT）、眼压及并发症发生率。结果2组治疗后各时间点BCVA均较治疗前显著提高（P＜0．05）,但2组间比较差异无统计学意义（P＞0．05）。2组治疗后各时间点CMT均较治疗前显著降低（P＜0．05）,但2组间比较差异无统计学意义（P＞0．05）。雷珠单抗组治疗后各时间点眼压与治疗前比较差异无统计学意义（ P＞0．05）;曲安奈德组治疗后各时间点眼压均较治疗前和雷珠单抗组显著提高（ P＜0．05）。曲安奈德组和雷珠单抗组眼压升高发生率比较,差异有统计学意义（P＜0．05）。结论玻璃体内注射雷珠单抗治疗RVO继发CME,可有效提高BCVA、降低CMT,其效果与曲安奈德相当,且安全性更高。     

Fluocinolone acetonide for the treatment of diabetic macular edema

Introduction: Fluocinolone acetonide intravitreal implant is a non-erodible implant approved for the treatment of diabetic macular edema (DME) insufficiently responsive to available therapies.

Areas covered: The injectable intravitreal implant releases fluocinolone acetonide at an average rate of 0.2 µg/day for at least 36 months. The two pooled pivotal FAME trials showed that, in patients with DME previously treated with laser photocoagulation, fluocinolone acetonide intravitreal implant was more beneficial than sham injection when looking at the proportion of patients with an improvement from baseline in visual acuity of more than 15 letters at 24 months and at 36 months. Cataract (82%) and intraocular pressure (IOP) elevation (37%) were the most common adverse events. Raised IOP was mostly treated with IOP-lowering medications, with <5% of eyes requiring incisional IOP-lowering surgery. FAME trial program results are confirmed by a series of real-world studies in eyes with chronic/recalcitrant DME.

Expert opinion: data indicate that fluocinolone acetonide intravitreal implant is a useful second-line option for the treatment of DME.     

Drug safety evaluation of intravitreal triamcinolone acetonide

Introduction: Triamcinolone acetonide (TA) is a steroidal drug that has been widely administered intravitreally for retinal and choroidal conditions. Safety of steroidal products for intraocular use is essential because of their risk of ocular adverse events. This review comprehensively discusses the safety of intravitreal administration of TA.

Areas covered: This paper analyzes the mechanisms of action and key pharmacokinetic attributes and provides a discussion of the main clinical trials investigating clinical applications of intravitreal TA. The safety of intravitreal TA is evaluated through a search of the Medline database from 1980 to 2011. The most relevant literature on the safety of intravitreal TA is also discussed.

Expert opinion: The complications of intravitreal TA therapy include secondary ocular hypertension in about 20 – 40% of eyes, steroid-induced cataract in about 15 – 20% of cases and postinjection infectious endophthalmitis and pseudoendophthalmitis in less than 1%. TA is an effective drug for various retinal and choroidal diseases when delivered intravitreally. It may imply an off-label use and it may be associated with ocular adverse events. Intravitreal TA is not associated with significant systemic safety risks.     

Sustained-release fluocinolone acetonide intravitreal insert for macular edema: clinical pharmacology and safety evaluation

Introduction: Inflammation plays a key role in the pathological processes leading to macular edema. Sustained release, low-dose intraocular corticosteroid delivery devices provide long-term anti-inflammatory therapy. Recently, a novel fluocinolone acetonide intravitreal insert (FAi, Iluvien), has been introduced with promising long-term results in the treatment of macular edema.

Areas covered: An extensive review of the literature in the English language was performed to provide comprehensive information on the pharmacological properties of FAi and its safety and efficacy data from various multi-center randomized clinical trials.

Expert opinion: The FAc, Retisert is a sustained-release device that is surgically implanted in the vitreous and has been approved by the US FDA for the treatment of non-infectious intermediate, posterior or panuveitis. FAi was developed after FAc and is an intravitreal corticosteroid delivery system that allows controlled release of therapeutic levels of fluocinolone acetonide (FA). Initial efficacy and safety data suggest that this delivery system maintains clinical effectiveness for up to 3 years after a single delivery of the device. This second-generation fluocinolone delivery device has shown superior safety results in clinical trials compared to the previous version of the higher dose FAc (0.59 mg). Sustained delivery preparations may help to reduce the treatment burden and its associated risks by decreasing the frequency of intravitreal injections. However, much needs to be learnt from additional clinical trials, post-marketing surveillance and results of extension studies. Concerns of intravitreal corticosteroids, such as cataract and increase in intraocular pressure, remain major challenges for this therapeutic strategy.     

Retinal thickness fluctuations in patients receiving fluocinolone acetonide implant for diabetic macular edema

Abstract

Objectives: To evaluate central foveal thickness (CFT) variability and accompanying changes in visual acuity (VA) 12?months before and after treatment with the 190?mcg fluocinolone acetonide (FAc) intravitreal implant for diabetic macular edema (DME).

Methods: The Iluvien Clinical Evidence cohort study in the United Kingdom (ICE-UK) investigated the effectiveness of the FAc implant in people treated at 13 hospitals from April 2013 to April 2015. The following parameters were calculated for CFT for each patient: mean, standard deviation (SD), retinal thickness amplitude (RTA, the difference between maximum and minimum values), and coefficient of variation (CV).

Results: In 149 eyes with ≥2 CFT observations both before and after FAc implantation, the median VA was 50 ETDRS letters at implantation. Mean CFT was 487?µm at implantation and 135?µm at 12?months post-implant. Before implantation, the mean CV and mean SD for CFT were 24.6% and 112?µm, respectively; the mean RTA was 254?µm. A statistically significant (p?<?.001) decrease in all three parameters was observed after implantation (18.3%, 68.2?μm and 146?μm, respectively). There was an association between CFT change between extremes and the corresponding change in VA (Pearson’s correlation coefficient, r = ?0.292, p?<?.001, prior to the implant; r = ?0.379, p?<?.001, post-implant).

Conclusions: After accounting for the reduction in CFT, retinal thickness stabilized following FAc implantation. There might be VA benefits in reducing variability in CFT over time. This merits further exploration but would require more frequent CFT observations in order to properly determine patterns of retinal thickness variability.     

Fluocinolone acetonide for the treatment of diabetic macular edema

In addition to VEGF inhibitors such as ranibizumab, aflibercept or bevacizumab, clinical and experimental investigations have revealed the great potential of steroids in the treatment of DME. At present two intravitreal steroid inserts are approved for the treatment of DME containing either dexamethasone or fluocinolone acetat (FA) as a pharmacological compound. The non degradable intravitreal FA insert releases 0.2 µg FA per day (Iluvien, Alimera Sciences). Clinical phase III studies have demonstrated the beneficial effect of the FA insert to last up to three years, especially in patients with a prolonged history of DME of at least three years at the initiation of therapy. While the treatment appears to be well tolerated over all, side effects such as cataract formation in nearly all treated phakic patients and raise of intraocular pressure need to be discussed with the patients as potential complications of the treatment.     

玻璃体切割术联合曲安奈德治疗糖尿病性黄斑水肿的黄斑区变化

目的探讨玻璃体切割术联合曲安奈德治疗糖尿病性黄斑水肿的黄斑区变化。方法采用前瞻性研究方法,选择2013年12月至2016年4月在我院诊治的糖尿病性黄斑水肿患者142例(142眼),根据信封随机抽签法分为观察组与对照组,各71例,对照组给予玻璃体切割术,观察组在玻璃体切割术术前5~7 d应用曲安奈德注射治疗,记录两组视力与黄斑区变化。结果术后1个月观察组与对照组的视力明显好于术前(P<0.05),观察组术后1个月视力明显好于对照组(P<0.05)。观察组与对照组术后1个月的黄斑中心凹厚度分别为(168.34±22.19)、(267.35±34.11)μm,均明显低于术前的(516.35±45.20)、(522.14±23.01)μm(P<0.05),观察组明显低于对照组(P<0.05)。观察组术后1个月玻璃体积血、新生血管性青光眼、瞳孔区膜性渗出等并发症发生率为8.5%,对照组为9.6%,两组比较差异无统计学意义(P>0.05)。结论玻璃体切割术联合曲安奈德治疗糖尿病性黄斑水肿能减轻黄斑水肿,缩小黄斑区域,从而促进术后视力的提高,且具有很好的安全性。     

Upcoming therapeutic advances in diabetic macular edema: an intravitreal dexamethasone drug delivery system

Introduction: Diabetes mellitus, through its ophthalmic complications diabetic retinopathy and diabetic macular edema (DME), is a leading cause of vision loss in industrialized countries.

Areas covered: This review covers laser treatment, which is a standard treatment strategy that has proven efficacy and safety through large clinical trials in DME. Several intravitreal drug applications currently being investigated are also discussed.

Expert opinion: First results suggest that the administration of anti-VEGF compounds is effective for DME. However, frequent injections may compromise safety. In order to enhance patient compliance, sustained delivery systems are being evaluated as potential treatment approaches. So far, only steroids have been included as active in such non-biodegradable or biodegradable delivery systems. Non-biodegradable systems are more complicated to administer as surgery is required and they need to be retrieved at the end of treatment. Also, in some cases safety issues have arisen, especially around intraocular pressure control. A new biodegradable dexamethasone delivery system seems to show promising efficacy results in addition to a more favorable safety profile, which will potentially improve patient compliance. All new therapeutic approaches, alone and in combination, will need to demonstrate their efficacy and safety in DME in future trials.     

Emerging drugs for diabetic macular edema

Introduction: Diabetic macular edema (DME) is the most common cause of visual impairment due to diabetic retinopathy. The treatment of DME has recently undergone a paradigm shift. Traditionally, photocoagulation was standard treatment, but pharmacologic therapies are becoming increasingly used for this purpose. All currently available drug therapies for DME are either anti-VEGF agents or corticosteroids.

Areas covered: The pathogenesis of DME involves angiogenesis, inflammation and oxidative stress. The scientific rationale to treat DME through the pharmacologic blockade of VEGF and other pro-angiogenic factors is discussed. The fluocinolone insert is approved for the treatment of DME in several European countries, but not in the US at this time. Some medications that are already approved for other retinal diseases, most prominently aflibercept and the dexamethasone delivery system, have recently obtained approval for DME in the US. Other compounds are being studied in earlier-phase clinical trials.

Expert opinion: Pharmacologic treatment of DME will likely become increasingly used, especially for patients with edema involving the fovea. At this time, the two main classes of medication for treatment of DME are anti-VEGF agents and corticosteroids. As we continue to collect clinical trials data, the precise role of individual agents, and the continuing role for photocoagulation, will become more clear.     

Photodynamic therapy combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization

The aim of this research was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injection of triamcinolone acetonide (TA) in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and pathological myopia. PDT combined with intravitreal injection of TA was performed on 16 eyes of 16 patients with CNV diagnosed by visual acuity, fluorescein fundus angiography (FFA) and optical coherent tomography (OCT), including 14 eyes secondary to age-related macular degeneration and two eyes secondary to pathological myopia. TA was injected intravitreally 72 h post PDT on 12 eyes and from three months to one year (mean nine months) post PDT on four eyes respectively. All the patients were followed up for 3 to 18 months (mean 18.6 months). Best-corrected visual acuity, intraocular pressure, retinal thickness and FFA were observed. The visual acuity was improved in seven eyes (43.8%) of all the 16 eyes and stable in nine eyes (56.2%), respectively. FFA revealed complete or partial closure of CNV in all patients. OCT showed that the macular edema disappeared or was alleviated. Transient intraocular pressure elevation occurred in one patient (6.25%) of all the 16 eyes and intraocular pressure returned to the normal after a transient treatment with antiglaucoma medication. The mean number of PDTs during the first year was 1.1. PDT combined with intravitreal injection of TA for CNV is safe and effective. It can reduce the risk of visual loss and the treatment frequency. __________ Translated from Chinese Journal of Ocular Fundus Diseases, 2007, 23(1): 13–16 [译自: 中华眼底病杂志]     

Pharmacotherapeutic efficacy of preservative-free intravitreal triamcinolone acetonide

Preservative-free formulations of triamcinolone acetonide have recently been introduced to the market over concerns of local toxicity of the vehicle and preservatives, including benzyl alcohol in the original formulation, which was not designed for intraocular use. The pharmacokinetics and pharmacodynamics of intravitreal triamcinolone (IVTA) are discussed. The therapeutic effects of IVTA include improvement of visual acuity and reduction of macular edema. However, ongoing treatment is usually required to maintain its effects. The efficacy of IVTA for both FDA-approved and ‘off-labeled’ indications is reviewed. Elevation of intraocular pressure and cataract formation are the two major side effects of IVTA; these are manageable but require close long-term follow-up. More studies are required to determine the optimal dosage and treatment frequency in different posterior segment disease.     

The effect and safety of intravitreal injection of ranibizumab and bevacizumab on the corneal endothelium in the treatment of diabetic macular edema

Objective: To investigate the effect and safety of intravitreal injection (IVI) of bevacizumab and ranibizumab on corneal endothelial cell count and morphology in patients with diabetic macular edema.

Materials and methods: A total of 60 eyes from 60 consecutive patients who received 0.5?mg/0.05?ml IVIs of bevacizumab (n?=?30, IVB group) or 1.25?mg/0.05?ml ranibizumab (n?=?30, IVR group) for three consecutive months were investigated prospectively. Specular microscopy was performed to evaluate endothelial cell count, the percentage of hexagonal cells (pleomorphism), and the coefficient of variation of the cell size (polymegathism); optical biometry was performed to evaluate central corneal thickness. Results before injection and 1 month after the first and third injections were compared.

Results: The groups were matched for age (p?=?0.11) and gender (p?=?0.32). There was no significant difference in endothelial cell count (IVB group, p?=?0.66; IVR group, p?=?0.74), pleomorphism (IVB group, p?=?0.44; IVR group, p?=?0.88) and polymegathism (IVB group, p?=?0.21; IVR group, p?=?0.24) before injection or 1 month after the first and third injections. There was also no difference in central corneal thickness (IVB group, p?=?0.15; IVR group, p?=?0.58) before injection or 1 month after the first and third injections.

Conclusion: Monthly 1.25?mg/0.05?ml IVIs of bevacizumab or 0.5?mg/0.05?ml of ranibizumab for three consecutive months in the treatment of diabetic macular edema does not affect corneal morphology and has no harmful effects on the endothelium.     

Intravitreal dexamethasone implant Ozurdex in the treatment of diabetic macular edema in patients not previously treated with any intravitreal drug: a prospective 12-month follow-up study

Abstract

Objective: To evaluate the mid-long-term efficacy and safety of the dexamethasone intravitreal (DEX) implant (Ozurdex¹) in naïve patients with diabetic macular edema (DME).

Methods: Prospective and single-center study conducted on consecutive patients with a diagnosis of DME, who received a DEX implant and were followed up for at least 12?months. The main outcomes measurements were the mean change in best corrected visual acuity (BCVA) and in foveal thickness (FT) as compared to the baseline values.

Results: Of the 84 screened patients 50 were included in the study. The BCVA significantly improved from 52.4 (20.4) letters at baseline to 62.6 (15.6), 61.2 (18.4), 61.6 (18.6), 60.6 (19.0), and 60.6 (18.8) at 2, 4, 6, 12?months and end of follow-up period, respectively (repeated measures ANOVA and the Greenhouse-Geisser correction; p?=?.0008). At the end of the follow-up period, a gain of BCVA of ≥5, ≥10, and ≥15 letters were observed in 26 (52.0%), 18 (36.0%), and 16 (32.0%) patients, respectively. The mean FT was significantly reduced from 446.0 (139.9) µm at baseline to 327.2 (103.6) at the end of follow-up (repeated measures ANOVA and the Greenhouse-Geisser correction; p?=?.0008). During the study follow-up, the patients receive a mean of 3.4 (2.9–3.9) implants. Of the 32 phakic eyes at baseline, 17 (53.1%) either developed new lens opacity or progression of an existing opacity.

Conclusion: In eyes with DME not previously treated with intravitreal drugs, DEX implants provide meaningful functional and anatomical benefits, and these results are sustained mid–long-term.     

玻璃体腔曲安耐德预防糖尿病玻璃体切割术后再出血

目的探讨增殖性糖尿病视网膜病变玻璃体切割术中应用曲安耐德预防术后眼内再出血的可行性。方法增殖型糖尿病视网膜病变患者30人（34眼）,随机分为治疗组20眼,术中玻璃体腔注射曲安耐德25mg;对照组14眼,玻璃体切割术后未行曲安耐德玻璃体腔注射。主要观察指标为术后早期玻璃体出血发生率,再次手术率及眼压、视力及白内障发生率。平均随访时间6个月。结果治疗组和对照组术后早期再出血率分别为1/20（5%）和4/14（28.57%）,（P〈0.01）。再次手术率分别为0/20（0%）和3/14（21.43%）（P〈0.001）。术后6月视力治疗组较好（P〈0.01）。术后1d眼压治疗组高于对照组（P〈0.01）。结论本临床研究表明,玻璃体腔注射曲安耐德有效降低增殖型糖尿病视网膜病变玻璃体切割术后眼内再出血复发率。     

玻璃体腔注射康柏西普治疗糖尿病性和视网膜静脉阻塞性黄斑水肿的疗效对比观察

目的：对比研究糖尿病和视网膜静脉阻塞继发黄斑水肿患者玻璃体腔注射康柏西普治疗临床疗效差异。方法：选取自2016年3月-2017年10月收入某院行玻璃体腔注射康柏西普治疗糖尿病性黄斑水肿者21例/30只眼,视网膜静脉阻塞性黄斑水肿者35例/35只眼。回顾性对比观察这2组患者治疗后1个月、3个月及末次随诊时者最佳矫正视力（BCVA）和中央黄斑区视网膜厚度（CMT）及其变化,以及治疗有效率、黄斑水肿复发率、治疗病程和注药次数等,采用方差分析的方法对这些指标进行组间和组内统计学比较。结果：比较康柏西普玻璃体腔内注射治疗后1个月、3个月及末次随访时与治疗前基线的BCVA差值（ΔBCVA）和CMT差值（ΔCMT）,静脉阻塞组均高于糖尿病组并具有显著性（P<0.05）。静脉阻塞组和糖尿病组治疗有效率分别为100%和86.7%,复发率为14.3%和20.0%;静脉阻塞组和糖尿病组的患者治疗病程分别为（4.40±1.90）个月和（5.72±3.03）个月,注药次数为（2.51±0.74）次和（3.07±1.34）次,均具有显著性（P<0.05）。所有患者治疗随访过程中未见明显与药物、玻璃体腔注射相关的眼部和全身不良事件的发生。结论：玻璃体腔内注射康柏西普治疗视网膜静脉阻塞性和糖尿病性黄斑水肿均有较好疗效,但静脉阻塞患者其黄斑水肿消退和视力提升更为显著和迅速,而糖尿病患者治疗病程更长,需要更多次（3次以上甚至更多次）注药才能控制黄斑水肿的病情。     

The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema

Objective: To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema.

Methods: Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40?mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically.

Results: Forty-one eyes of 41 patients with a mean age of 63.49?±?10.99 (55–86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p?<?0.001, p?<?0.001 and p?=?0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p?<?0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case.

Conclusion: PSTA application is an effective and safe option in BRVO-related macular edema.