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1.
目的 评价全视网膜光凝前行后Tenon囊下注射曲安奈德在治疗糖尿病视网膜病变上的临床疗效及安全性.方法 采用随机、双眼平行对照的研究方法筛选于我院就诊的糖尿病视网膜病变患者,将双眼患有增生型糖尿病视网膜病变或严重非增生型糖尿病视网膜病变的24例(48眼)患者分为两组,对照组仅行全视网膜光凝,试验组在行全视网膜光凝前1周先行后Tenon囊下注射曲安奈德20 mg 6个月后观察最佳矫正视力(logMAR)、视网膜厚度以及眼压的变化.结果 治疗后6个月与治疗前视力相比较,对照组最佳矫正视力有所降低,而试验组有所提高,两组治疗后6个月最佳矫正视力相比差异有统计学意义(P=0.04).治疗后6个月与治疗前视网膜厚度相比较,对照组黄斑中心凹厚度增加了32.8μm,试验组降低了9.7 μm,两组相比差异有统计学意义(P=0.03);对照组旁中心凹厚度增加了23.2μm,试验组降低了5.1 μm,两组相比差异有统计学意义(P=0.04);对照组中心凹周边厚度增加了18.3 μm,试验组增加了0.5 μm,两组相比差异无统计学意义(P=0.06).随访期内,试验组和对照组眼压波动均在正常范围之内.结论 全视网膜光凝前行后Tenon囊下注射20 mg曲安奈德能有效降低糖尿病性黄斑水肿,是预防由视网膜激光引起的视力下降安全有效的方法  相似文献   

2.
目的 观察曲安奈得后Tenon囊下注射对糖尿病性视网膜病变全视网膜光凝术引起的持续性黄斑水肿的疗效.方法 2007年1月至2011年12月因糖尿病性视网膜病变进行标准全视网膜光凝(PRP)治疗的患者.激光治疗前进行最佳矫正视力、眼压、散瞳眼底、眼底荧光血管造影和OCT等检查.PRP术后1个月复查,最佳矫正视力较PRP前下降2行以上,同时OCT检查出现明显黄斑水肿的患者进行曲安奈得40 mg后Tenon囊下注射.注射后1周、1个月复查最佳矫正视力、眼压、散瞳眼底检查和OCT.结果 共有7例11只眼行全视网膜光凝术后出现视功能下降超过2行,OCT显示出现明显黄斑水肿.曲安奈得治疗后一周所有患者视功能均有提高,OCT显示黄斑水肿均减轻.一个月时眼视功能恢复至激光治疗前水平,OCT显示黄斑基本恢复激光治疗前,黄斑水肿完全消退.所有随访时间未见有眼压升高患者.结论 后Tenon囊下注射曲安奈得是治疗糖尿病性视网膜病变全视网膜光凝术后持续性黄斑水肿的简单有效治疗方法.  相似文献   

3.
目的:研究后Tenon囊下注射20mg曲安奈德(TA)治疗黄斑水肿后的眼压变化及眼压升高的影响因素。方法:黄斑水肿患者46例46眼,病因为糖尿病性视网膜病变16例,年龄相关性黄斑变性13例,视网膜静脉栓塞11例,后葡萄膜炎6例,均行后Tenon囊下注射20mgTA。注射前测量眼压,并于注射后2wk;1,2,3,4,5,6mo随访观察眼压变化。结果:患者46例术后2wk;1,2,3,4,5,6mo平均眼压较术前均有升高。术后3mo时,平均眼压达最高值(19.22±6.86)mmHg,有17例(37%)患者IOP〉21mmHg。术后2wk;1,2,3,4,5mo眼压与术前比较,差别有统计学意义(值分别为3.747,5.836,5.982,5.866,4.202,3.246,均P〈0.05),术后6mo眼压与术前比较,差别无统计学意义(t=1.446,P〉0.05)。年轻、基础眼压高是后Tenon囊下注射曲安奈德后继发性眼压升高的危险因素(χ2值分别为5.599,10.323,均P〈0.05),而性别、病因与后Tenon囊下注射曲安奈德后继发性眼压升高没有相关性(χ2值分别为0.022,0.050,均P〉0.05)。结论:后Tenon囊下注射20mg曲安奈德,引起眼压升高较为常见,在注射后3mo时眼压升高最为明显,注射后6mo时回落至基础眼压水平。年轻、基础眼压高是继发性眼压升高的危险因素。注射后进行最短为期6mo的眼压随访是非常必要的,尤其是对于年轻患者及基础眼压高的患者。  相似文献   

4.
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。  相似文献   

5.
背景 曲安奈德具有抗光作用,脉络膜脱离型视网膜脱离(RD/CD)术前玻璃体腔内注射TA可减轻炎症反应,改善手术效果,但由于术前眼压低,玻璃体腔注射易引起并发症.关于后Tenon囊下注射TA在RD/CD中的有效性和安全性尚未见报道. 目的 探讨后Tenon囊下注射TA治疗RD/CD的疗效及安全性.方法 采用回顾性研究方法,收集于2010年5月至2014年6月在温州医科大学附属眼视光医院首诊为RD/CD且接受手术的患者22例22眼的病历资料,患眼均于玻璃体切割术前5d行后Tenon囊下注射TA混悬液40 mg(0.4 ml),注药后观察葡萄膜的炎性反应.使用Goldmann眼压计和B型超声仪观察注药前及注药后5d患眼眼压、脉络膜脱离高度及脱离范围的变化,同时监测血压及血糖的变化,并于注药5d后行玻璃体切割术,所有患者术后随访3个月以上. 结果 行TA的后Tenon囊下注射的22眼葡萄膜炎症状均不同程度减轻;注药前患眼平均眼压为(5.4--.2.9) mmHg(1 mmHg=0.133 kPa),注射TA后5d患眼平均眼压为(8.2±4.3) mmHg,眼压上升2.8 mmHg,差异有统计学意义(t=3.430,P<0.01).注药前患眼平均脉络膜脱离高度为5.2(3.1,6.6)mm,注药后5d平均脉络膜脱离高度为0.9(0,3.8)mm,脉络膜脱离高度显著降低,差异有统计学意义(Z=-4.198,P<0.01).注药前患眼平均脉络膜脱离范围为12(10,12)个点位,注药后5d平均脉络膜脱离范围为3(0,6)个点位,脱离范围显著下降,差异有统计学意义(Z=-4.124,P<0.01).患者注药前后血糖、血压变化的差异均无统计学意义(均P>0.05).术眼术前、术后1个月和3个月LogMAR视力分别为2.14±0.46、1.29±0.57和1.17±0.55,术后视力较术前明显好转,总体比较差异有统计学意义(F=22.060,P<0.001).视网膜复位率为95.5%.7眼术后出现高眼压,其中5眼使用局部降眼压药物治疗后恢复,2眼药物取出后眼压恢复正常. 结论 RD/CD术前行TA后Tenon囊下注射能减轻术眼葡萄膜炎反应,升高眼压及降低脉络膜脱离,对血糖、血压影响小.  相似文献   

6.
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.  相似文献   

7.

目的:比较后Tenon囊下注射曲安奈德与静脉滴注地塞米松联合玻璃体切除手术治疗脉络膜脱离型视网膜脱离(RD/CD)的临床效果。

方法:回顾性选取2014-03/2017-10于我院眼科确诊为RD/CD并采取玻璃体切除手术治疗的病例52例52眼,根据术前的干预治疗方式分为:A组(27例27眼)术前3~5d行每天1次的静脉滴注地塞米松治疗,B组(25例25眼)术前5d行后Tenon囊下注射曲安奈德治疗。检测两组干预前后术眼的眼压、CD情况,术后1、3mo及末次随访的视网膜复位、视力及并发症情况。

结果:干预后,B组术眼眼压8.09±3.56mmHg,明显高于本组干预前5.65±2.19mmHg和A组干预后6.25±2.53mmHg(P<0.05); A、 B组患者术眼的CD高度3.98(1.01, 5.34)、0.92(0.03, 3.88)mm,明显低于干预前5.22(3.14, 6.64)、5.16(3.34, 7.71)mm; CD位点6.0(3.0, 10.0)、3.0(0.0, 6.0)个,明显低于干预前11.0(9.0, 12.0)、10.0(8.0, 12.0)个,其中 B组术眼的CD高度和CD位点数均低于A组(P<0.05)。术后至末次随访,A、B组的术眼视网膜成功复位率分别为78%和96%(P>0.05)。术后1、3mo和末次随访,A组的术眼视力为1.69±0.79、1.39±0.72、1.38±0.61均优于干预前的2.06±0.28,B组的术眼视力为1.42±0.66、1.29±0.56、0.97±0.51均优于干预前的2.02±0.58,其中 B组术后末次随访术眼视力均优于A组(P<0.05)。术后1、3mo,A组均有4眼高眼压,明显少于 B组的11、12眼(P<0.05); 至末次随访,A组仍有1眼高眼压,B组有2眼(P>0.05)。

结论:RD/CD治疗中,后Tenon囊下注射曲安奈德联合玻璃体切除手术治疗的效果明显好于静脉滴注地塞米松联合玻璃体切除手术治疗,但需作好术后眼压监测,如出现眼压偏高需及时处理。  相似文献   


8.
目的 观察视网膜光凝联合玻璃体腔注射曲安奈德(TA)治疗糖尿病引起的弥漫性黄斑水肿的临床疗效.方法 选用糖尿病性黄斑水肿患者25例(36只眼),随机选18只眼行玻璃体腔注射TA联合视网膜光凝治疗,称联合组;另18眼行单纯视网膜光凝治疗,称单纯组.两组治疗后(1、3、6)月观察最佳矫正视力,黄斑水肿情况.结果 联合组在1、3、6月最佳矫正视力高于单纯组,黄斑水肿吸收好且快于单纯组,差异有统计学意义(P<0.05).结论 视网膜光凝联合玻璃体腔注射TA可促进糖尿病性黄斑水肿吸收并改善视力.  相似文献   

9.
关红英  李双农 《眼科研究》2009,27(6):507-510
目的探讨后Tenon囊下注射曲安奈德(TA)后玻璃体腔内的药物质量浓度及代谢情况。方法32只健康成年有色家兔,右眼为实验眼,给予后Tenon囊下注射TA20mg(0.1mL);左眼为对照眼,给予后Tenon囊下注射生理盐水0.1mL,依据注射后不同时间点分为第1、3、7天,2、3、4、6、8周8个亚组,于注药前及注药后各时间点行裂隙灯检查、眼压测量并处死1组家兔,取玻璃体样本,用高效液相色谱法测定药物质量浓度并行药物代谢动力学分析。结果所有家兔未见手术及药物所致的并发症。玻璃体腔内药物质量浓度于第2周达到最高,为(1.91±0.13)μg/mL,以后逐渐下降。结论后Tenon囊下注射TA,在玻璃体腔内可达到并维持一定的药物质量浓度。  相似文献   

10.
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 .  相似文献   

11.
目的:研究弥漫型糖尿病黄斑水肿(DME)患者全视网膜光凝(PRP)前,予以TA(曲安奈德注射后 Tenon's 囊下)治疗的临床效果。方法:回顾分析我院2008-10/2012-05以来,于我科治疗的96例96眼弥漫型DME患者临床资料,依据治疗方式将其分为研究组与对照组,每组48例48眼,对照组仅予以PRP治疗,研究组PRP 1wk前,予以TA治疗,在6mo后对比两组BCVA(最佳的矫正视力)及视网膜厚度改变情况,对两组眼压变化予以分析。结果:经治疗后,两组6mo随访发现,对照组同治疗前相较,其BCVA呈降低表现,研究组呈升高表现,两组具有明显差异(P〈0.05),并且在随访期内,两组患者眼压均在正常范围内波动变化,不具差异(P〉0.05),研究组黄斑中心凹厚度降低9.6μm,对照组增高31.9μm,呈明显差异(P〈0.05),研究组旁中心凹厚度降低5.0μm,对照组增加22.1μm,呈明显差异,研究组中心凹周边厚度增加0.4μm,对照组增加19.4μm,不具差异(P〉0.05)。结论:弥漫型DME患者PRP前,予以TA治疗,安全有效,并且优于单纯进行PRP治疗,可以在基层医院推广实施。  相似文献   

12.
BACKGROUND: Despite the benefits of intraocular steroids for the treatment of inflammatory, neovascular, proliferative, and edematous diseases, one of the side effects is raised intraocular pressure (IOP). In this study, we attempted to identify when IOP elevates, peaks, and returns to the preinjection baseline IOP after intravitreal or posterior sub-Tenon administration of triamcinolone acetonide, as well as the factors that might affect IOP. METHODS: Retrospective case review was undertaken of 69 patients (82 eyes), who received either a 4 mg intravitreal (16 eyes) or a 20 mg posterior sub-Tenon (66 eyes) triamcinolone acetonide injection. IOP assessment for each eye was completed at the preinjection baseline and at the first, third, and sixth month of follow-up. RESULTS: The mean IOP of all eyes increased significantly at each follow-up. The mean maximum elevation ratio from the baseline was 4.0 (SD 5.2) mm Hg. An elevation of 5 mm Hg or greater occurred in 28 eyes (34.1%). The maximum elevation correlated significantly with age (p < 0.01). The incidence of an elevation of 5 mm Hg or greater was significantly higher among patients younger than 60 years (p < 0.01) and relatively higher among female patients (p = 0.051). The mean IOP increased significantly at the first month after intravitreal injection but at all follow-up periods after posterior sub-Tenon injection. There was no significant difference in IOP elevation according to disease type, although eyes with diabetic retinopathy tended to be at higher risk of IOP elevation. Two eyes of two female patients, who had received posterior sub-Tenon injections for the treatment of diabetic retinopathy, required glaucoma surgery. INTERPRETATION: The IOP elevation of 5 mm Hg or greater observed in 34.1% of the eyes was consistent with past reports. IOP elevation was associated with patients of less than 60 years of age and with female sex, and it lasted longer after posterior sub-Tenon injection than after intravitreal injection. Careful assessment of IOP during a follow-up period of at least 6 months is paramount, especially in younger female patients after posterior sub-Tenon injection.  相似文献   

13.
目的 观察后Tenon囊下注射曲安奈德(TA)对激光光凝后糖尿病大鼠视网膜炎症相关细胞因子表达的影响。方法 雄性Brown Norway健康大鼠48只,通过腹腔注射链脲佐菌素建立糖尿病大鼠模型。将大鼠随机分成实验组、对照组和空白组,分别为20、20、8只大鼠。实验组、对照组大鼠行激光光凝后,给予后Tenon囊下注射TA或生理盐水50 μl。空白组不作任何处理。激光光凝后1、3、7 d,采用荧光定量聚合酶链反应和酶联免疫吸附试验检测大鼠视网膜中血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的mRNA和蛋白表达。结果 激光光凝后1、3、7 d,实验组和对照组分别与空白组比较,其VEGF、IL-6、TNF-α mRNA和蛋白表达均明显升高,差异均有统计学意义(P<0.05)。实验组VEGF、IL-6、TNF-α mRNA和蛋白表达均较对照组明显下降。实验组与对照组比较,激光光凝后1 d,VEGF mRNA表达间差异无统计学意义(P>0.05);其余各时间点VEGF、IL-6、TNF-α mRNA和蛋白表达间差异均有统计学意义(P<0.05)。结论 后Tenon囊下注射TA可有效降低激光光凝导致的糖尿病大鼠VEGF、IL-6、TNF-α表达水平的升高。  相似文献   

14.
Purpose  To determine whether a posterior sub-Tenon injection of triamcinolone acetonide (TA) before focal photocoagulation is safe and effective in patients with diabetic macular edema. Methods  Sixteen eyes of 11 diabetic patients with unresolved diffuse macular edema were treated with a 20-mg sub-Tenon injection of TA 1 to 2 months before focal photocoagulation. Focal photocoagulation was applied only to microaneurysms, and grid laser photocoagulation was not performed. The main outcome measures used were visual acuity (VA), central macular thickness (CMT) determined by optical coherence tomography (OCT), and the fluorescein angiographic appearance of the retina. Patients were followed for at least 6 months. Results  One month after the sub-Tenon injection of TA, the macular edema was resolved with a significant reduction of the CMT on OCT. VA improved slightly. Subsequent focal photocoagulation of the microaneurysms maintained the significant reduction of CMT for up to 6 months. A significant improvement of VA was observed in 37.5% patients at 6 months, and there was no decrease in VA in any of the patients. Conclusions  A 20-mg sub-Tenon TA injection prior to focal laser photocoagulation is a safe and beneficial treatment in patients with diabetic macular edema. An erratum to this article can be found at  相似文献   

15.
PURPOSE: This study investigated the effects of posterior sub-Tenon capsule (PST) injection of triamcinolone acetonide (TA) on intraocular pressure (IOP) in the human eye. METHODS: The study included 115 patients who received PST injections of 40-mg TA to treat macular edema with diabetic retinopathy (n=57), branch retinal vein occlusion (n=35), central retinal vein occlusion (n=13), or other disorders (n=10). IOP measurements were performed on the day of injection, and 0.5, 1, 2, 3, 6, 9, and 12 months later. RESULTS: In 26 (22.6%) of the 115 eyes, an IOP of 24 mm Hg or higher was observed during the 12-month follow-up period after PST TA injection. IOP elevation significantly correlated with young age, but not with past history of diabetes mellitus or systemic hypertension, sex, or type of retinal disease with macular edema. In total, 23 eyes were treated with antiglaucoma medications to control elevated IOP (24 mm Hg or higher). External trabeculotomy was performed in 1 case where medications failed to correct elevated IOP. CONCLUSIONS: PST TA injection is associated with high rates of steroid-induced IOP elevation in eyes with previously normal IOP. However, IOP elevation may be less common after PST injection than after intravitreal injection. Our findings indicate that IOP must be carefully monitored after PST TA injection.  相似文献   

16.
Objective: To report the incidence, intraoperative findings, and surgical outcome of secondary ptosis that developed after a sub-Tenon injection of triamcinolone acetonide (TA).Study Design: Retrospective, cross-sectional study.Participants: One hundred forty-seven cases with a total of 286 sub-Tenon TA injections.Methods: The medical records of 163 eyes of 147 cases treated with a sub-Tenon injection of 10 mg or 20 mg TA were reviewed. The incidence of secondary ptosis (palpebral fissure >2 mm narrower than that of the fellow eye) after a sub-Tenon TA injection was determined. The preoperative levator function and margin reflex distance (MRD) of the affected eyes, and the intraoperative findings in eyes that underwent reconstructive surgery, were evaluated.Results: Eight eyes (5%) developed secondary ptosis after the injection and 6 eyes were treated by reconstructive surgery. The preoperative levator function of the affected eyes did not differ from that of the fellow eyes. Intraoperatively, no septal disruption or fat herniation was noted, but an aponeurotic disinsertion was identified and repaired with an advancement of the leading edge to the anterior tarsal plate. The surgery led to satisfactory results, with improvement of the MRD from −1.3 (SD 1.5) mm preoperatively to 2.3 (SD 0.5) mm postoperatively (p = 0.027). Additional sub-Tenon TA injections were required in 2 eyes after eyelid surgery but the ptosis did not worsen.Conclusions: A sub-Tenon TA injection can occasionally cause ptosis by inducing a disinsertion of the levator aponeurosis. However, surgical reconstruction can lead to successful resolution of the ptosis.  相似文献   

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PURPOSE: Macular edema is one of the serious side effects associated with panretinal photocoagulation (PRP). The inhibitory effect of triamcinolone acetonide (TA) on leukocyte-endothelial cell interactions in vivo after PRP was evaluated. METHODS: Argon laser photocoagulation was performed in one half of the retinas in male Brown Norway rats. Experimental rats were injected with 2 mg TA (50-microL volume) in the posterior sub-Tenon space, and the vehicle-treated rats were injected with the same amount of saline (50 microL) immediately after PRP. Untreated rats were used as the control. Leukocyte dynamics in retinal microcirculation and retinal vessel diameters were evaluated 1 day after laser photocoagulation with the use of acridine orange digital fluorography. Retinal thickness was evaluated with optical coherence tomography. RESULTS: The number of rolling leukocytes and accumulating leukocytes in the retina decreased by 66% in the TA-treated rats (P < 0.01) and by 24% (P < 0.05), respectively, compared with the number in the vehicle-treated rats. Retinal thickness in the vehicle-treated rats was significantly thicker than that in control rats 1 day after laser photocoagulation (P < 0.01). Retinal thickness in the TA-treated rats was significantly suppressed compared with that in the vehicle-treated rats (P < 0.05). CONCLUSIONS: Sub-Tenon administration of TA significantly suppressed leukocyte dynamics in rat retinal microcirculation and decreased retinal edema after laser photocoagulation. The results suggest that the suppression of leukocyte-endothelial cell interactions in retinal microcirculation may be one mechanism responsible for the therapeutic effect of sub-Tenon TA on postlaser retinal edema.  相似文献   

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