Intravitreal triamcinolone injection for chronic diabetic macular oedema with severe hard exudates

Background The purpose of the study was to determine the efficacy and safety of intravitreal triamcinolone acetonide (TA) in chronic diabetic macular oedema with severe hard exudates. Methods This prospective, interventional consecutive case series study consisted of 33 eyes of 28 patients with chronic diabetic macular oedema and severe foveal hard exudates who received an intravitreal injection of 4 mg of TA. The patients were divided into two groups according to the type of foveal hard exudates: group I, plaque-like (17 eyes) and group II, dot-like scattered hard exudates (16 eyes). The results of both groups, evaluated by colour fundus photography and fluorescein angiography, were compared and complications were recorded. Results All patients completed at least 6 months of follow-up. In all eyes, the hard exudates were completely resolved (24% in group I and 50% in group II) or decreased (76% in group I and 50% in group II). In group I, the mean diameter of the exudates plaques significantly decreased from 5.5±3.8 mm² in the pre-treatment period to 2.2±2.7 mm² at the end of the follow-up period. There was no recurrence of the hard exudates in either of the groups. The mean ± SD visual acuity (VA) improved from 0.07±2.5 at the baseline to a maximum of 0.09±2.1 lines in group I (P<0.01) and from 0.13±3.9 to a maximum of 0.27±2.7 lines in group II (P<0.01). The mean VA improvement in group II was better than group I (3.2±2.5 vs. 1.4±1.0 lines, P<0.05). Intraocular pressure exceeded 21 mmHg in 10 eyes (30%), which was then controlled by topical medication. Three eyes (9%) exhibited signs of subcapsular cataract progression. Conclusions Intravitreal TA appears to be a valuable treatment in chronic diabetic macular oedema with severe foveal hard exudates. In all eyes in this study the hard exudates were completely resolved or decreased, and the mean VA improved significantly in both groups. However, the VA improvement was significantly worse in eyes with plaque-like exudates suggesting the possible value of earlier treatment. Further studies would enable the assessment of the universal effectiveness of this treatment. This study was presented in part at the 4th European Vitreoretinal Society (EVRS) Meeting, Istanbul, Turkey, 12–15 September 2004     

Intravitreal triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema

Background: To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema. Design: Prospective, non‐randomized, masked, interventional case series. Participants: Twenty‐four eyes of 24 subjects with centre‐involved diabetic macular oedema extending over two disc‐areas with predominant cystic changes on spectral domain optical coherence tomography were selected. Methods: Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide. Main Outcome Measures: Change in central macular volume on spectral domain optical coherence tomography and best‐corrected visual acuity were measured at 6‐week follow‐up. Results: Baseline data were matched in both groups. Post‐injection central macular volume (7.46 ± 0.73 mm³) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre‐injection central macular volume (9.11 ± 1.0 mm³) or when compared with the post‐injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm³). However, post‐injection best‐corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best‐corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre‐injection central macular volume (r = 0.55, P = 0.005). Conclusions: Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best‐corrected visual acuity.     

Nine‐month results of intravitreal bevacizumab versus triamcinolone for the treatment of diffuse diabetic macular oedema: a retrospective analysis

Objective: To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME). Methods: This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline. Results: After 1‐, 3‐, 6‐ and 9‐month follow‐up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group. Conclusion: In our study collective, neither IBe nor ITA treatment was able to improve VA during follow‐up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline.     

玻璃体内注射曲安奈德联合黄斑部格栅样光凝治疗弥漫性糖尿病性黄斑水肿

目的　评价玻璃体内注射曲安奈德（ｔｒｉａｍｃｉｎｏｌｏｎｅａｃｅｔｏｎｉｄｅ,ＴＡ）联合黄斑部格栅样光凝治疗弥漫性糖尿病性黄斑水肿（ｄｉａｂｅｔｉｃｍａｃｕｌａｒｅｄｅｍａ,ＤＭＥ）短期的临床疗效和安全性。方法　将３５例（３９眼）弥漫性ＤＭＥ患者根据治疗方法不同分为２组,分别为单纯ＴＡ治疗组（２４眼）和联合治疗组（ＴＡ注射联合黄斑部格栅样光凝术,１５眼）。其中联合治疗组在ＴＡ注射１个月后行黄斑部格栅样光凝术,距ＴＡ注射术后３个月、６个月分别观察２组患者最佳矫正视力、眼压、裂隙灯显微镜、彩色眼底照相、ＯＣＴ及并发症情况。结果　治疗后３个月,单纯ＴＡ治疗组和联合治疗组最佳矫正视力分别为０．１６±０．０８、０．１６±０．１７,黄斑中心凹视网膜厚度分别为（２７２．２±５９．４）μｍ、（２７９．０±９８．９）μｍ,眼压分别为（１５．４±４．３）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、（１４．９±３．２）ｍｍＨｇ,２组间最佳矫正视力、黄斑中心凹视网膜厚度和眼压比较差异均无统计学意义（均为Ｐ＞０．０５）;治疗后６个月,单纯ＴＡ治疗组和联合治疗组最佳矫正视力分别为０．２７±０．０３、０．２８±０．１５,黄斑中心凹视网膜厚度分别为（２８９．２±３３．９）μｍ、（２４８．０±１０２．７）μｍ,眼压分别为（１５．５±２．３）ｍｍＨｇ、（１５．１±３．５）ｍｍＨｇ,２组间最佳矫正视力、黄斑中心凹视网膜厚度和眼压比较差异亦均无统计学意义（均为Ｐ＞０．０５）。与治疗前视力相比,两组在治疗后３个月、６个月均有所提高,与治疗前黄斑中心凹视网膜厚度相比,两组均有所下降,与治疗前眼压相比,两组无明显变化。结论　与单纯ＴＡ注射相比,玻璃体内注射ＴＡ联合黄斑部格栅样光凝治疗弥漫性ＤＭＥ短期内疗效和安全性并不占据明显优势。鉴于本次病例观察时间较短,尤其再次治疗的患者例数较少,故其远期疗效、安全性仍有待大样本的长期观察。     

康柏西普联合曲安奈德球内注射治疗糖尿病黄斑水肿

目的：探讨康柏西普联合曲安奈德球内注射治疗糖尿病性黄斑水肿的疗效。

方法：回顾性队列研究。合并黄斑水肿的糖尿病患者40例43眼,治疗前记录BCVA、IOP和OCT检查。根据治疗方式分为两组,A组患者给予玻璃体腔注射康柏西普联合曲安奈德治疗,B组给予玻璃体腔注射康柏西普治疗。分别于治疗后1d,1、4、8、12、24wk记录BCVA、IOP和CMT及并发症等情况。

结果：A组治疗后不同时间点的视力与治疗前(0.83±0.03)相比均有差异(P<0.05),治疗8wk时达到最佳视力(0.23±0.04); 治疗后CMT与治疗前(612.4±47.6μm)有差异(P<0.05); 24wk内平均注射次数2.7次。B组治疗后不同时间点视力与治疗前(0.79±0.09)有差异(P<0.05),治疗4wk时达到最佳视力(0.25±0.06)。治疗后CMT与治疗前(597.8±62.4μm)有差异(P<0.05),24wk内平均注射次数3.6次。两组患者第一针与第二针治疗间隔时间有差异(P<0.05)。两组患者治疗前后眼压无差异(P>0.05)。

结论：康柏西普联合曲安奈德球内注射治疗糖尿病性黄斑水肿安全、有效、见效快,但疗效更持久,且可降低打针频率。     

Intravitreal triamcinolone for persistent cystoid macular oedema in eyes with quiescent uveitis

Background:  To determine the outcome following injections of triamcinolone acetate (IVTA) in the treatment of persistent cystoid macular oedema (CMO) in quiescent, non-infectious uveitis.
Methods:  Retrospective analysis of patients with inactive uveitis requiring/not requiring immunosuppressive therapy who received IVTA because of chronic CMO refractory to previous systemic steroids. Number of IVTA (re-)treatments, distance visual acuity, near visual acuity, mean foveal thickness, intraocular pressure, duration of CMO, type of uveitis and systemic therapy were assessed previous to and 1, 4, 12 weeks following each IVTA treatment.
Results:  Between March 2003 and May 2006, 24 eyes of 18 patients received between one and three IVTA injections. A resolution of chronic CMO was observed in 7/24 eyes (29.2%, 5 eyes after single injection of IVTA, 1 eye each after two and three injections of IVTA), a significant increase in distance visual acuity in 9/24 eyes (37.5%; 5 eyes with resolution of CMO, 4 eyes despite persistent CMO) and in near visual acuity in 13/24 eyes (54.6%; 6 eyes with resolution of CMO, 7 eyes despite persistent CMO).
Conclusions:  IVTA might be considered as a treatment for patients with chronic CMO when persistent despite previous systemic steroid therapy. Even patients without sustained resolution of CMO after IVTA might benefit in terms of transiently increasing visual acuity, but progression of cataract and rise in intraocular pressure limit repeatability.     

Macular function after intravitreal triamcinolone acetonide injection for diabetic macular oedema

Purpose: We aimed to evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on macular function in patients with diabetic macular oedema (DMO). Methods: Eleven eyes in 11 patients with DMO were enrolled. In each eye, at baseline and at 30 days after IVTA injection, logMAR visual acuity (VA), macular sensitivity, fixation stability and fixation location by MP‐1 microperimetry and optical coherence tomography (OCT) foveal thickness were assessed. Results: Thirty days after IVTA injection, eyes with DMO showed a significant (p < 0.001) reduction in foveal thickness and significant (p < 0.01) increases in logMAR VA and MP‐1 retinal sensitivity (p < 0.001). There was also significant (p = 0.046) improvement in fixation location and some improvement in fixation stability, although the latter was not significant (p = 0.08). Conclusions: In eyes with DMO, short‐term improvement in retinal sensitivity and fixation properties can be achieved by IVTA injection.     

曲安奈德玻璃体腔注射治疗糖尿病性黄斑水肿34例

目的:评估玻璃体腔注射曲安奈德(intravitreal triamcinolone acetonide,IVTA)治疗糖尿病性黄斑水肿(diabetic macular edema,DME)的疗效。方法:DME患者34例39眼,采用40g/LIVTA0.1mL,治疗后1,3,6mo对比观察最佳矫正视力(best corrected visual acuity,BCVA),眼压、裂隙灯、光相干断层扫描(optical coherence tomography,OCT)、荧光素眼底血管造影(fundus fluorescein angiography,FFA)改变。结果:治疗前平均视力0.11±0.18,治疗后1,3,6mo平均视力分别提高至0.33±0.23,0.36±0.24,0.30±0.22,与治疗前比较差异均有统计意义(P<0.01)。OCT检查黄斑中心凹视网膜厚度(central macular thickness,CMT)治疗前603±150μm,治疗后1,3,6mo明显降低(P<0.01)分别是295±90μm,261±84μm,282±92μm。治疗后FFA检查荧光渗漏消失或明显减轻。8眼(21%)接受2次IVTA,眼压升高>22mmHg7眼。1眼发生后囊混浊性白内障。结论:IVTA治疗DME,能有效提高视力,降低黄斑视网膜厚度。     

曲安奈德两种给药方式治疗糖尿病性黄斑水肿的疗效对比观察

目的观察曲安奈德注射液玻璃体腔注射（IVI）和Tenon囊下给药（STi）治疗糖尿病性黄斑水肿的疗效。设计回顾性病例系列。研究对象37例通过荧光素眼底血管造影（FFA）和相干光断层扫描（OCT）诊断的糖尿病性黄斑水肿患者。方法分别给予一次性曲安奈德（4mg）玻璃体腔注射（n=19）或三次（0d、2w、4w）Tenon囊下给药（40mg／次）（n=18）。治疗后4、8、12、16、20、24W复查最佳矫正视力、眼底、眼压、FFA、OCT,评价其疗效。主要指标视力、视网膜黄斑中心凹厚度、眼压。结果32例患者完成了24周的观察研究。IVI组治疗前及治疗后24周的视力分别为（0．10±0．03）、（0．24±0．06）（F=15．459,P=0．000）;黄斑中心凹视网膜厚度分别为（460．73±46．33）μm、（394．53±41．43）μm（F=25．282,P=0．0000）。STi组治疗前及治疗后24周的视力分别为（0．11±0．04）、（0．18±0．07）（F=6．989,P=0．000）;黄斑中心凹视网膜厚度分别为（454．76±56．28）μm、（424．94±42．69）μm（F=5．145,P=0．000）。同一时间点,IVI的治疗效果较STi更显著,差异具有统计学意义（P均〈0．05）。两组患者未出现严重、不可逆转并发症。结论曲安奈德玻璃体腔注射和Tenon囊下多次给药均是治疗糖尿病性黄斑水肿的有效方法;玻璃体腔注射效果更显著,Tenon囊下给药更安全。（眼科,2009,18：246—250）     

玻璃体腔内注射曲安奈德治疗糖尿病性弥漫性黄斑水肿

目的:观察玻璃体腔内注射曲安奈德治疗糖尿病性弥漫性黄斑水肿的疗效。方法:经检眼镜、光相干断层扫描及荧光素眼底血管造影检查证实的糖尿病性弥漫性黄斑水肿患者25例(25眼),玻璃体腔内注射40g/L的曲安奈德0.1mL,随访6mo,对比观察治疗前后视力、眼压及黄斑区视网膜厚度变化。结果:治疗后1,3,6mo,平均视力分别为0.20±0.15,0.35±0.20,0.21±0.18,与治疗前的0.08±0.04相比,其差异具有统计学意义;黄斑区视网膜厚度分别为360.7±50.2,263.2±60.1,313.5±86.4μm,与治疗前的463.4±105.1μm相比,其差异具有统计学意义。结论:玻璃体腔内注射曲安奈德治疗糖尿病性弥漫性黄斑水肿短期内能有效改善黄斑水肿,提高视力,但其长期疗效和安全性需进一步研究。     

曲安奈德玻璃体腔注射治疗弥漫性糖尿病黄斑水肿的临床观察

目的:研究曲安奈德玻璃体腔注射联合黄斑部格栅样光凝治疗弥漫性糖尿病黄斑水肿效果。方法:对35例37眼弥漫性糖尿病黄斑水肿患者随机分为两组单纯玻璃体腔曲安奈德注射组及联合黄斑部格栅样光凝治疗组,其中光凝组在注药后1mo行黄斑部格栅样光凝,分别对比各组治疗前及治疗后1,3,6mo视力及黄斑厚度进行统计分析。结果:单纯曲安奈德注射组注药后1,3mo视力分别为0.28±0.19、0.22±0.14较注射前视力0.15±0.13提高,有统计学意义(P<0.05),治疗后6mo视力为0.17±0.10与治疗前视力无统计差异(P>0.05),黄斑厚度注药后1,3,6mo分别为231.82±61.02μm、255.12±92.66μm、349.06±116.19μm均较注药前469±136.60μm减轻(P<0.01),但治疗后6mo较3mo黄斑厚度明显增加有统计学意义(P<0.01),提示黄斑水肿复发;联合治疗组注药后1,3,6mo视力为0.27±0.17、0.25±0.15,0.23±0.13,与治疗前视力0.14±0.11对比均明显提高(P<0.01),黄斑厚度治疗后1,3,6mo分别为245.68±74.85μm、257.36±79.44μm、276.57±99.64μm较治疗前黄斑厚度473.33±123.22μm显著减轻(P<0.01),但6mo与3mo黄斑厚度对比无显著增加(P>0.05)。观察期间29%患眼出现眼压升高,经局部降眼压药物治疗后得到控制。结论:曲安奈德玻璃体腔注射联合黄斑部格栅样光凝治疗弥漫性糖尿病黄斑水肿,能减轻黄斑水肿,提高患者视力,但仍需进一步长期临床观察。     

小剂量曲安奈德玻璃体腔内注射治疗黄斑水肿

目的评价小剂量曲安奈德玻璃体腔内注射治疗黄斑水肿的效果和安全性。方法31例(31眼)黄斑水肿患者,其中糖尿病性黄斑水肿19例、视网膜中央静脉阻塞性黄斑水肿8例、白内障术后黄斑水肿4例,所有患者均行6mg曲安奈德玻璃体腔内注射。在注射后1周、1个月、2个月、3个月对患者视力、眼压进行检查并行黄斑部光相干断层扫描检查黄斑区视网膜厚度和黄斑区视网膜总容积。结果所有患者的视力在注射后均有一定升高,经LogMAR转换后注射前和注射后3个月视力分别为0.620±0.334和0·455±0·313(P<0.05);黄斑区视网膜厚度和容积下降,注射后3个月分别为(312±146)μm和(2.61±0.27)mm3,与注射前相比[(484±216)μm和(3.76±0.56)mm3]差异有显著性意义(P<0.05)。随访1周、1个月、2个月时的平均眼压[(18.1±6.4)mmHg、(18.9±6.3)mmHg、(17.6±5.8)mmHg,1kPa=7.5mmHg]较注射前平均水平[(14.2±4.6)mmHg]显著升高(P<0.05)。随访期内1例患者因白内障进展而需手术治疗。结论至少3个月随访期内,小剂量曲安奈德玻璃体腔内注射治疗黄斑水肿安全有效,没有严重并发症。     

Intravitreal and posterior subtenon triamcinolone acetonide in idiopathic bilateral uveitic macular oedema

PURPOSE: To study the efficacy of intravitreal triamcinolone acetonide (IVTA) versus posterior subtenon triamcinolone acetonide (PSTA) in bilateral macular oedema secondary to idiopathic intermediate uveitis. METHODS: In a prospective, interventional case series, 10 patients (20 eyes) with bilateral uveitic macular oedema were included. Patients underwent fundus fluorescein angiography, record of visual acuity and intraocular pressure (IOP). Patients received IVTA 4 mg/0.1 mL in one eye and PSTA 20 mg/0.5 mL in the fellow eye at an interval of > or =4 weeks. The outcome measures were record of IOP, best corrected visual acuity and angiographic resolution of cystoid macular oedema at 3 and 6 months. RESULTS: The mean pre-intervention IOP at baseline between the IVTA and the PSTA group was comparable. At 1 week, the mean IOP recorded was greater in the eyes that received IVTA than those that received PSTA (P < 0.001). However, at 1- and 3-month follow up, the mean IOP between the two groups was similar. Best corrected visual acuity of > or =6/12 achieved at 3 and 6 months in the IVTA and PSTA group was comparable (77.8% vs. 44.4% [P = 0.14] and 88.9% vs. 77.8% [P = 0.53]). There was also no significant difference in angiographic resolution of cystoid macular oedema at 3 (P = 0.32) and 6 months (P = 0.53) between the two groups. Recurrence of macular oedema was seen in one and two eyes that received IVTA and PSTA, respectively, at 6 months. CONCLUSION: Triamcinolone acetonide injection, whether administered intravitreally or via posterior subtenon route, is an effective treatment option in achieving complete anatomic and functional improvement in cases treated for macular oedema secondary to idiopathic intermediate uveitis.     

玻璃体腔注射曲安奈德治疗糖尿病性视网膜病变黄斑水肿

目的:研究玻璃体腔注射曲安奈德(triamcinolone ace-tonide,TA)治疗糖尿病视网膜病变黄斑水肿的有效性。方法:2004-06/2006-01确诊的31例(34眼)糖尿病性视网膜病变黄斑水肿患者,行玻璃体腔注射TA(4mg/0.1mL)治疗。对比分析治疗前后三个参数:最佳矫正视力、OCT检测黄斑中心凹厚度、眼压。随访时间3～10(平均6)mo。结果:患者31例(34眼),年龄50～75(平均63)岁。OCT检测黄斑中心凹厚度治疗前平均518±95μm,治疗随访6mo后平均220±89μm(P<0.05);最佳矫正视力范围治疗前为4.0～4.5,平均4.0±0.15,治疗后为4.1～4.6,平均4.3±0.15(P>0.05);所有患者眼压都有升高,升高值2.0～4.5(平均3.5)mmHg(P>0.05),但都在正常眼压范围之内。没有其他并发症发生。结论:玻璃体腔注射TA是治疗糖尿病性视网膜病变黄斑水肿的有效方法,但患者的视力没有明显的提高。     

Pattern electroretinogram for monitoring the efficacy of intravitreal triamcinolone injection in diabetic macular edema

Purpose: To investigate the efficacy of intravitreal triamcinolone (IVT) by evaluation of pattern electroretinogram (PERG) in diabetic patients with clinically significant macular edema (CSME). Methods: Forty eyes of 40 diabetic patients were treated with 8 mg of IVT injection as primary therapy for CSME. The main outcome measures included best-corrected visual acuity, fundus fluorescein angiography, P₅₀ amplitudes of pattern electroretinogram (PERG) and intraocular pressures before and after injection. Results: The mean follow-up time was 6.1 months. Mean visual acuity improved significantly from a mean LogMAR value of 1.14 ± 0.16 at baseline to a maximum of 0.73 ± 0.30. The mean baseline P₅₀ amplitude of PERG before intravitreal injection was 1.5 ± 0.9 V. After the treatment, it was 2.l ± 1.1 V at 1-month, 2.4 ± 1.0 V at 3-month and 2.1 ± 0.9 V at last visit and the differences were significant when compared with baseline values (for each, p < 0.001). Temporary increases in intraocular pressures were controlled with topical antiglaucomatous medications, if required. Conclusion: IVT injection provides rapid improvement in visual acuity of diabetic patients with CSME that has been supported by P₅₀ amplitudes of PERG. P₅₀ amplitudes of PERG may be used as novel predictive value in the evaluation of the effectiveness of IVT injection.     

曲安奈德玻璃体内注射联合激光光凝治疗黄斑水肿的临床研究

目的观察激光光凝联合曲安奈德玻璃体内注射治疗黄斑水肿的疗效。方法将40例(40眼)黄斑水肿患者分为单纯光凝组和联合注药组,每组20眼,分别行黄斑格栅样光凝和黄斑格栅样光凝联合玻璃体内注射40g·L-1曲安奈德0.1mL治疗,观察治疗前及治疗后1个月、3个月、6个月2组患者视力和黄斑中心凹厚度的变化,并观察术后并发症情况。结果单纯光凝组和联合注药组术前平均视力分别为0.11±0.09和0.12±0.10,黄斑中心厚度分别为(535±147)μm和(527±145)μm,2组间差异均无统计学意义(均为P>0.05)。治疗后1个月、3个月、6个月,单纯光凝组和联合注药组平均视力分别为0·19±0.09和0.42±0.09、0.24±0.09和0.38±0.10、0.24±0.09和0.42±0.09;黄斑厚度分别为(405±150)μm和(248±164)μm、(354±124)μm和(279±133)μm、(325±124)μm和(285±118)μm,2组间比较差异均有统计学意义(均为P<0·05)。光凝组术后1例患者眼压升高,联合注药组6例眼压升高,经药物治疗后均恢复正常;联合注药组治疗后2例患者黄斑水肿复发,经再次注药后1例治愈;随访期内均未见严重并发症发生。结论曲安奈德玻璃体内注射联合激光光凝治疗黄斑水肿可较快提高视力、减轻黄斑水肿、减少水肿复发。     

Intravitreal triamcinolone as adjunctive treatment to laser panretinal photocoagulation for concomitant proliferative diabetic retinopathy and clinically significant macular oedema

Purpose: To evaluate the effect of intravitreal injections of triamcinolone acetonide (IVTA) combined with panretinal photocoagulation (PRP) on visual acuity (VA) and foveal thickness in patients with concomitant high‐risk proliferative diabetic retinopathy (PDR) and clinically significant macular oedema (CSMO). Methods: This retrospective interventional case series included seven eyes diagnosed with both high‐risk PDR and CSMO that underwent PRP and a single injection of 4 mg of IVTA. The main outcome measures were VA and foveal thickness, measured by optical coherence tomography (OCT) before treatment and throughout the follow‐up period. Results: Median follow‐up was 301 days (range 180–715 days). Foveal thickness data were available for four of seven eyes. Before the combined treatment, median LogMAR (logarithm of the minimum angle of resolution) VA and median foveal thickness were 1 (Snellen 20/200, range 20/40–20/800) and 559 µm (range 333–689 µm), respectively. After treatment, median vision improved to LogMAR 0.544 (Snellen 20/70, range 20/40–20/1000) (P = 0.13). Vision improved or remained stable in six of seven eyes. Median foveal thickness at final follow‐up was 436 µm (range 259–623 µm) (P = 0.15). Foveal thickness decreased or remained stable in all eyes. Conclusion: The addition of IVTA to PRP in the treatment of eyes with high‐risk PDR and CSMO may prevent PRP‐induced foveal thickening and loss of vision.     

Factors associated with variability in response of diabetic macular oedema after intravitreal triamcinolone

Purpose:  To identify factors associated with variability in anatomical and functional response of diabetic macular oedema (DMO) after 4 mg of intravitreal triamcinolone acetonide (ivTA), and for recurrence of macular oedema.
Design:  Pooled analysis of individual data from two randomized controlled trials.
Methods:  This was a multicentre study involving 107 eyes with DMO administered 4 mg ivTA. Predictive factors for response to treatment were evaluated with linear regression analysis. Factors associated with time to recurrence of oedema were studied with Cox proportional hazards modelling. Main outcome measures were maximum improvement in optical coherence tomography (OCT)-measured central foveal thickness (CFT) and best-corrected visual acuity (BCVA), final CFT and BCVA at 12 months and time to oedema recurrence.
Results:  Greater reduction of retinal thickening occurred in eyes with worse baseline thickening ( P  < 0.001). There was also greater improvement of visual acuity in eyes with poorer preoperative BCVA levels ( P  < 0.001). Age, duration of oedema and previous macular laser treatment had no significant effect on maximal BCVA or CFT improvement. Eyes given 4 mg triamcinolone alone were more likely to develop recurrence of oedema at 12 months than those given a combination of 4 mg triamcinolone plus sequential laser (hazard ratio 2.60 [95% confidence interval: 1.45–4.67]).
Conclusion:  Baseline OCT-measured retinal thickening and BCVA are important predictors of maximal anatomical and functional response of DMO to ivTA, respectively. Combination treatment strategy using sequential laser therapy may have a role in delaying recurrence of oedema after triamcinolone.     

Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion

Purpose: To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO). Methods: Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best‐corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired‐t test. Side‐effects were monitored. Results: BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow‐up, BCVA and CFT were significantly different compared to pre‐injection values in the same group (P = 0.032, 0.049 in the initial‐injection group and P = 0.001, 0.008 in the repeat‐injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time‐point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post‐injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study. Conclusion: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.     

玻璃体内注射雷珠单抗与曲安奈德治疗糖尿病黄斑水肿的疗效对比分析

目的　对比分析玻璃体内注射雷珠单抗与曲安奈德治疗糖尿病黄斑水肿的临床疗效。方法　选取就诊于我院眼科的糖尿病黄斑水肿患者４７例（４８眼）,病程６～１４个月;分为雷珠单抗组２４例２４眼,曲安奈德组２３例２４眼;分别给予玻璃体内注射雷珠单抗０．０５ｍＬ与曲安奈德０．０５ｍｇ,比较两组治疗１周、１个月、３个月、６个月患眼的最佳矫正视力、黄斑中心凹视网膜厚度、眼压及眼底黄斑区荧光素渗漏情况,观察治疗后的效果。结果　雷珠单抗组与曲安奈德组治疗后１周、１个月、３个月患眼的最佳矫正视力均得到提高,分别为０．０８±０.０２与０．０６±０．０３、０．２１±０．０３与０．１７±０．０５、０．２９±０．０７与０．２７±０．０４,治疗后短期内两组间差异无统计学意义（Ｐ值分别为０．０８２、０．０９２、０．３２０）;治疗６个月后,曲安奈德组患眼的最佳矫正视力（０．１８±０．０３）有５例出现回降现象;而雷珠单抗组患眼的最佳矫正视力（０．２８±０．０９）变化趋于稳定,两组间的差异有统计学意义（Ｐ＝０．００３）。治疗后１周、１个月、３个月、６个月雷珠单抗组与曲安奈德组患眼的黄斑中心凹视网膜厚度分别为（３３６．００±９４．７１）μｍ与（３７８．００±８９．７４）μｍ、（２５１．００±６３．５５）μｍ与（２７３．００±８１．２９）μｍ、（２６３.００±５９．４２）μｍ与（２６７．００±４９．３２）μｍ、（２３８．００±４２．６１）μｍ与（２９８．００±３３．２７）μｍ,治疗后各时间点两组间的差异均无统计学意义（Ｐ＝０．１２７、０．０７１、０．０５３、０．０５８）。另外,治疗后各时间点两组的眼压均在正常范围内,并且黄斑区荧光渗漏均无明显增强现象。结论　玻璃体内注射雷珠单抗和曲安奈德治疗糖尿病黄斑水肿,均能有效控制糖尿病视网膜病变患者病情发展并能改善视力。两种疗法的疗效在短期内差异无统计学意义,治疗６个月后,雷珠单抗疗效的稳定性优于曲安奈德。