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.     

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。     

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。     

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。     

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。     

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。     

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.     

Early versus late intravitreal triamcinolone acetonide for macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of or 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.     

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.     

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.     

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。     

玻璃体腔内注射康柏西普治疗黄斑部小分支视网膜静脉阻塞导致的黄斑水肿

目的：评价玻璃体腔内注射康柏西普治疗黄斑部小分支视网膜静脉阻塞继发黄斑水肿的有效性及安全性。

方法：回顾性分析2015-07/2016-09在我院确诊为黄斑小分支视网膜静脉阻塞继发黄斑囊样水肿的患者资料19例19眼,所有患者均按3+按需注射(pro re nata,PRN)的方法行玻璃体腔内注射康柏西普0.05mL(0.5mg),每月随诊观察最佳矫正视力、中央视网膜厚度、注射次数及眼部相关并发症等。

结果：治疗后1、2、3、6mo的最佳矫正视力与治疗前相比均有改善,差异具有统计学意义(P<0.01); 治疗后1、2、3、6mo的黄斑中心凹厚度与治疗前相比均下降,差异具有统计学意义(P<0.01); 其中有3眼出现反复发作的黄斑水肿,FFA检查显示微血管瘤渗漏,给予局部光凝封闭血管瘤后水肿吸收; 治疗及随诊期间所有患者均未出现玻璃体出血、视网膜脱离、持续高眼压和眼内炎等并发症。

结论：玻璃体腔注射康柏西普治疗黄斑小分支静脉阻塞继发的黄斑水肿安全有效,可以明显改善视力,减轻黄斑水肿; 顽固的黄斑水肿建议行FFA检查,如水肿为微血管瘤渗漏造成建议联合局部光凝治疗。     

玻璃体腔内注射TA与雷珠单抗治疗CRVO继发黄斑水肿的对照研究

目的：比较曲安奈德(TA)与雷珠单抗(ranibizumab)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发黄斑水肿的的临床疗效及安全性。

方法：回顾性分析继发黄斑水肿的CRVO患者40例40眼。其中20例20眼接受玻璃体腔注射TA(1mg,0.1mL)治疗,其余20例20眼接受玻璃体腔注射雷珠单抗(0.5mg,0.05mL)治疗。观察两组治疗前及治疗后1,2wk; 1,2,3,6mo患者最佳矫正视力、黄斑中心凹厚度(CMT)及眼压的改变。

结果：TA组及雷珠单抗组于玻璃体腔注药1,2wk; 1,2,3,6mo后最佳矫正视力较治疗前明显提高(P<0.05); 但两组之间无明显差异(P>0.05)。两组于玻璃体注药后1,2wk; 1,2,3,6mo,CMT较治疗前有明显降低(P<0.05),但两组之间无明显差异(P>0.05)。TA组玻璃体腔注药后2wk及4wk眼压较治疗前明显升高(P<0.05)。雷珠单抗组玻璃体腔注药后各时间点眼压均无明显升高(P>0.05)。注药后第1,2wk; 2,3,6mo,TA组眼压改变与雷珠单抗组无明显差异(P>0.05),注药后1mo,TA组眼压改变要明显高于雷珠单抗组(P<0.05)。

结论：玻璃体腔内注射雷珠单抗是目前CRVO继发黄斑水肿的有效而且安全的治疗手段。与TA相比其在提高最佳矫正视力及降低CMT的同时几乎不会发生眼部及全身并发症。     

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。     

玻璃体腔注射改良低剂量曲安奈德治疗白内障术后黄斑囊样水肿

目的：探讨玻璃体腔注射改良低剂量曲安奈德(TA)治疗白内障术后黄斑囊样水肿(PCME)的疗效。

方法：回顾性分析。选取2015-01/2018-12于我院就诊的典型PCME 患者12例12眼行玻璃体腔注射改良低剂量TA。通过0.22μm的滤膜将TA 混悬液置换成眼内灌注液,取置换后的TA溶液2mg/0.05mL注射。观察注药后2wk,1、3、6mo的最佳矫正视力、黄斑中央厚度、眼压、局部和全身并发症。

结果：与注射前比较,所有患者注药后视力均显著提高; 黄斑中央厚度显著减低(P<0.05), 而眼压无明显升高(P>0.05),所有患者均未观察到眼部及全身并发症。

结论：玻璃体腔注射改良低剂量TA治疗PCME安全、有效,克服了以往导致眼压升高的副作用,价格低廉,能够使患者受益。但尚需大宗病例的临床随机对照研究和长期疗效的随访观察。     

Prospective comparisons of intravitreal injections of triamcinolone acetonide and bevacizumab for macular oedema due to branch retinal vein occlusion

Purpose: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO). Design: Prospective, comparative, randomized, interventional clinical trial. Methods: Forty‐three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4‐mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25‐mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best‐corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months. Results: Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow‐up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure–lowering medications. Conclusion: Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO.     

曲安奈德玻璃体腔重复注射治疗视网膜中央静脉阻塞性黄斑水肿的疗效评价

目的:研究玻璃体腔重复注射曲安奈德(intravitreal triam-cinolone,IVTA)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)引起的黄斑水肿的临床效果。方法:研究对象为17例17眼接受IVTA(4mg)单次及重复注射的CRVO性黄斑水肿患者,均为人工晶状体眼或无晶状体眼(男/女=10/7),重复注射时间均为首次注射后16wk。在术前及术后1,2,3,4mo,分别测量单次注射组和重复注射组最佳矫正视力(best-corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)。采用配对-t检验对两组结果进行统计学分析。结果:单次注射组与重复注射组术前BCVA和CFT相比无显著差异。两次注射后BCVA及CFT均有短暂提高,虽然在随访结束时两组的BCVA及CFT与注射前仍有显著差异(单次注射组:P=0.032,0.049,重复注射组:P=0.01,0.008)。但重复注射组每个时间点BCVA均显著低于单次注射组(P值分别是0.043,0.011,0.010和0.012)。在注射后1,2,3mo,重复注射组CFT均显著高于单次注射组(P值分别是0.040,0.015和0.025)。单次及重复注射后眼压最高水平分别是20.0mmHg(SD2.06)和18.56mmHg(SD3.65),两者之间无显著性差异(P=0.467)。在随访期间未发现其它明显的副作用。结论:在治疗视网膜中央静脉阻塞引起的黄斑水肿时,4mgIVTA重复注射效果要差于单次注射。