玻璃体腔内注射曲安奈德后的眼压变化

目的观察玻璃体腔内注射曲安奈德（TA）后的眼压变化。方法回顾性收集我院接受TA玻璃体腔注射治疗黄斑水肿的138例（138只眼）患者的临床资料。治疗前1d测量眼压,每眼测3次,取平均值。所有患者均接受4mgTA常规玻璃体腔内注射。治疗后1周、2周、1个月同样方法测量眼压,以后每个月复查1次,随诊半年。以眼压≥21mmHg为眼压升高。对比分析治疗前后眼压的变化。结果治疗后有22只眼眼压升高,占15.94%,其中92.8%的患者高眼压出现在3个月内,治疗后5个月有21只眼恢复到基础水平,有1只眼行小梁切除术,随访期峰值平均眼压（16.39±4.37）mmHg,注药前平均眼压（14.77±2.80）mmHg,对所有数据进行t检验（P=0.004,P〈0.01）有显著差异,按照性别、年龄因素分组分析,采用方差分析,各组之间无显著统计学意义。结论 TA玻璃体腔内注射后眼压升高较常见,眼压升高多发生于3个月内,注射后至少随诊观察6个月。大多数眼压高的患者眼压能控制到基础水平,极少数患者引起激素性青光眼需手术治疗。     

玻璃体腔内注射曲安奈德后早期眼压变化和前房穿刺对眼压的影响

目的观察玻璃体腔内注射曲安奈德（TA）后眼压的早期变化以及前房穿刺对眼压的影响。方法将接受玻璃体腔内注射TA治疗的20例20眼患者随机分为前房穿刺组（A组）和未进行前房穿刺组（B组）,各10例10眼。A组在玻璃体腔内注射TA后前房穿刺并抽取0.05 mL房水,B组仅玻璃体腔内注射TA。应用Goldmann眼压计于玻璃体腔内注射前及注射后2、15、30 min,1 h,1 d,1周测量眼压,对2组注射前后眼压的变化进行对比研究。结果 A组注射前平均眼压为（13.70±2.52）mmHg,注射后2 min时为（8.20±1.33）mmHg,15 min时为（11.32±1.52）mmHg,A组注射后2 min时的眼压明显低于组内其他时间点,差异均有统计学意义（P〈0.01）。B组注射前平均眼压为（15.32±1.73）mmHg,注射后2 min时为（39.23±9.31）mmHg,15 min时为（16.24±3.52）mmHg,B组TA注射后2 min眼压明显高于注射前,差异有统计学意义（P〈0.01）,注射后15 min恢复到正常眼压水平（16.24±3.52）mmHg。A组在注射后2 min的眼压明显低于B组同时间点的眼压,差异有统计学意义（P〈0.01）。A组注射后早期可见一过性前房闪辉,B组未见眼部不良反应。结论玻璃体腔内注射TA后早期可引起一过性眼压升高,可选择性进行前房穿刺。前房穿刺和玻璃体腔内TA注射是安全的。     

玻璃体腔注射曲安奈德治疗黄斑水肿的眼压变化

目的:研究玻璃体腔注射4mg曲安奈德(IVTA)治疗黄斑水肿后的眼压(IOP)变化及其相关因素。方法:本研究为回顾性、连续性及非对照病例序列研究。包括93眼黄斑水肿患者,病因分别为视网膜静脉阻塞(54眼)和糖尿病视网膜病变(39眼),都接受了4mgIVTA注射。所有病例均在注射前和注射后14d,1,2,3,4,5,6mo随访眼压变化。并分析基础IOP,病因,年龄和性别与眼压的相关性。结果:注射后14dIOP显著升高(16.02±2.45mmHg,P<0.001),注射后2mo达到高峰(18.80±6.20mmHg,P<0.001)。注射后14d有2眼眼压超高21mmHg(2.2%),术后1,2,3,4,5,6mo分别是14(15.1%),18(19.5%),9(9.6%),4(4.3%),0,0。注射后14d有1眼(0.01%)眼压较基础眼压升高超过5mmHg,术后2mo达到高峰,为22眼(23.7%)。注射后1mo有5眼(5.3%)眼压升高10mmHg,2mo最高为12眼(12.9%)。IOP升高和年龄(相关系数-0.18～-0.29,P<0.05),基础眼压(相关系数0.52～0.79,P<0.001)及糖尿病(相关系数0.23,P<0.001)显著相关,但与性别无相关性(相关系数-0.002～0.04,P>0.05)。所有患眼的IOP均能通过局部降眼压药物控制到正常,没有1例发生青光眼性视神经病变。结论:4mgIVTA注射后眼压升高是很普遍的现象,注射后应该至少随访观察6mo以上。所有患眼的高眼压均能通过局部降眼压药物得到控制。对于基础眼压较高,糖尿病视网膜病变及年轻患者更应该关注注射后的眼压变化。     

曲安奈德玻璃体腔注射的临床应用

曲安奈德注射液系一种长效糖皮质激素制剂，近年来采用其玻璃体腔内注射治疗一些难治性眼部疾病，临床中显示出良好的短期疗效，且无明显的近期视网膜毒副作用，为临床上治疗黄斑水肿、脉络膜新生血管、抑制增生性玻璃体视网膜病变等开辟了一条新途径，但对其远期疗效及毒副作用尚无统一的认识，还需要进一步研究、总结。临床中应严格掌握曲安奈德注射液玻璃体腔内注射的适应证，防止临床滥用现象的发生。     

曲安奈德玻璃体腔注射治疗黄斑水肿

目的评价玻璃体腔注射曲安奈德治疗黄斑水肿的疗效和安全性。方法回顾性分析玻璃体腔注射曲安奈德治疗黄斑水肿35例45眼,其中由糖尿病视网膜病变引起的弥漫性黄斑水肿15例25眼,由视网膜静脉阻塞引起者20例20眼。通过眼部检查(眼压、裂隙灯显微镜、双目间接检眼镜)、眼底荧光血管造影和光相干断层扫描证实有黄斑水肿。所有病例均按照标准的玻璃体腔注射操作方法,进行玻璃体腔一次性注射40g.L-1曲安奈德混悬液0.1mL。术后定期复查,随访6个月。主要观察指标包括:视力、眼压、黄斑区视网膜平均厚度、眼内炎症反应及晶状体改变。结果随访期末,所有患者中5眼视力无变化,1眼视力下降,39眼视力有不同程度的提高。注射后最后一次复查时视力:静脉阻塞组平均视力为0.35±0.23,与治疗前0.15±0.11相比,差异有统计学意义(t=2.671,P<0.05);糖尿病组平均视力为0.26±0.21,与治疗前0.12±0.08相比,差异亦有统计学意义(t=2.786,P<0.05)。所有患者治疗后黄斑水肿均减轻或者消退,但有3眼治疗后4～6个月出现黄斑水肿复发,1眼给予再次曲安奈德注射,黄斑水肿消退。15眼治疗后出现眼压升高至21mmHg(1kPa=7.5mmHg)以上,给予降眼压药物后眼压得以控制。有1眼白内障明显进展。结论玻璃体腔注射曲安奈德可有效治疗因视网膜静脉阻塞或糖尿病引起的黄斑水肿,但是其远期疗效有待进一步观察,一过性眼压升高是其最常见的不良反应。     

玻璃体腔内注射曲安奈德对兔视网膜超微结构的影响

本研究通过观察常规剂量（4mg）围产曲安奈德（triamcin-olone acetonide,TA）兔眼玻璃体腔内注射对视网膜超微结构的影响。     

曲安奈德玻璃体腔注射治疗黄斑水肿的临床观察

目的:观察曲安奈德(triarncinolone acetonide,TA)玻璃体腔注射治疗黄斑水肿(maeular edema,ME)的疗效。方法:对22例(26眼)黄斑水肿患者行玻璃体腔内注射曲安奈德后定期随访3a,观察治疗前后视力、眼压及眼底黄斑区改变情况。结果:全部患者玻璃体腔内注射曲安奈德后视力比术前提高,黄斑水肿消退或减轻。结论:玻璃体腔内注射曲安奈德可消除黄斑水肿,提高视力,但远期效果有待进一步研究。     

玻璃体腔注射曲安奈德术后并发症分析

目的探讨玻璃体腔内注射曲安奈德(TA)的并发症及防治措施。方法76例(76只眼)行玻璃体内注射曲安奈德(TA),对其并发症进行回顾性分析。结果28只眼出现眼压升高(36.9%);2只眼(2.6%)在短期内白内障加重明显;1只眼出现无菌性眼内炎(1.3%);2只眼(2.6%)在随访期间发生玻璃体出血。结论曲安奈德在临床的应用需进一步认真和谨慎地总结和研究,防止临床滥用现象的发生。对于玻璃体腔内注射曲安奈德的并发症,应提高认识,密切随访,发现问题及时处理。     

曲安奈德玻璃体腔内注射疗法的研究现状

曲安奈德(triamcinolone acetonide)是一种长效糖皮质激素，能抑制细胞免疫，减轻炎症及早期毛细血管的扩张，维持毛细血管的通透性，稳定血房水屏障，并且能限制纤维蛋白的渗出，抑制成纤维细胞分化、色素上皮细胞的增殖；同时，通过抑制血管外基质的转换而诱导血管内皮细胞功能改变或死亡，或间接促进炎症细胞形成抗血管生成的刺激因子，     

曲安奈德玻璃体腔注射治疗黄斑水肿的形态与功能观察

目的探讨曲安奈德(triamcinolone acetonide,TA)玻璃体腔注射治疗黄斑水肿(macularedema,ME)的疗效,并对其疗效进行评价。方法选择中央静脉阻塞、分支静脉阻塞、糖尿病视网膜病变以及视网膜复位术后的15例15眼ME患者作为研究对象,自颞下方角膜缘后4mm处玻璃体腔注射TA4mg,手术前后分别进行光学相干断层成像术和多焦视网膜电图(multifocalERG,mf-ERG)等方法检查。结果术前平均视力为(0.30±0.23),黄斑中心凹处神经上皮厚度为(452.46±122.35)μm,mf-ERG中心凹处(1环)N1波振幅密度为(19.51±9.27)nV.deg-2,P1为(23.42±10.78)nV.deg-2;术后3个月平均视力为(0.55±0.27),黄斑中心凹处神经上皮厚度为(225.46±102.53)μm,1环中心凹处N1波、P1波振幅密度分别为(27.44±9.01)nV.deg-2、(33.43±14.57)nV.deg-2。结论TA玻璃体腔注射是治疗各种原因ME的有效方法,mf-ERG是评价黄斑功能的有利手段。     

Complications of intravitreal injection of triamcinolone acetonide

BACKGROUND: Intravitreal injection of triamcinolone acetonide appears to be a promising treatment for a variety of proliferative, edematous, neovascular and inflammatory ocular disorders. Reported complications include intraocular pressure (IOP) elevation, cataract formation, retinal detachment, vitreous hemorrhage and endophthalmitis. The purpose of this investigation was to report the complications of intravitreal triamcinolone injection that may be attributable to the injection procedure or to the corticosteroid suspension. METHODS: A total of 212 eyes of 180 patients who underwent intravitreal triamcinolone acetonide injection for various indications were enrolled. All patients received 8 mg/0.2 mL of triamcinolone. A total of 270 injections were performed by the same surgeon under topical anesthesia. The patients were followed for a mean of 9.2 months. Complications related to the injection procedure and to the corticosteroid were recorded. RESULTS: The most common complication encountered during follow-up was transient elevation of the IOP above 21 mm Hg (44 eyes [20.8%]). The average IOP rose by 28.5%, 38.2%, 16.7% and 4.2% from baseline at 1, 3, 6 and 9 months respectively. The mean IOP values at 1, 3 and 6 months were statistically significantly higher than the mean preinjection value (p < 0.001). Fourteen eyes (6.6%) had cataract progression and underwent cataract surgery with intraocular lens implantation. Endophthalmitis developed in one eye (0.5%); the patient underwent vitrectomy with silicone oil injection. Pseudoendophthalmitis occurred in one eye (0.5%), and pseudohypopyon was observed in two eyes (0.9%). INTERPRETATION: Intravitreal triamcinolone injection was effective in a variety of ocular disorders. Patients should be monitored closely given the potential for complications of the injection procedure or the corticosteroid suspension.     

Changes of intraocular pressure after intravitreal injection of 4mg triamcinolone acetonide in treatment of macular edema

AIM: To investigate the changes of intraocular pressure (IOP) and associated factors of IOP elevation after 4mg intravitreal injection of triamcinolone acetonide (IVTA) in treatment of macular edema. ·METHODS: The study is prospective, consecutive, and non-comparative interventional case series including 93 eyes with macular edema associated with retinal vein occlusion ( =54 eyes) or diabetic retinopathy ( =39 eyes), which received 4mg IVTA injection. The change in IOP was followed for all cases at pre-operation and 14 days, 1, 2, 3, 4, 5, and 6 months post-operation. Associated factors of IOP elevation were examined regarding baseline IOP, causal disease, age and gender. ·RESULTS: IOP increased significantly ( <0.001) at 14 days 16.02 ± 2.45mmHg after injection and peaked at 18.80 ± 6.20mmHg at 2 months post-injection ( <0.001) from 14.85± 2.55 mmHg preoperatively. An IOP rise to the value higher than 21mmHg was observed in 2 (2.2%) eyes 14 days after injection and which was observed in 14 (15.1%), 18 (19.5%), 9(9.6%), 4(4.3%), 0, and 0 eyes respectively at 1, 2, 3, 4, 5, and 6 months after injection. One eye (1.07%) showed pressure elevation of over 5mmHg than baseline 14 days after injection and IOP peaked to 22mmHg (23.7%) at 2 months after injection. Five (5.3%) eyes had an increase of 10mmHg at 1 month and IOP peaked to 12mmHg (12.9%) at 2 months after injection. The rise in IOP was statistically associated with younger age (correlation coefficient -0.18- -0.29, <0.05), high baseline IOP (correlation coefficient 0.52-0.79, all <0.001), and the presence of diabetes mellitus (correlation coefficient 0.23, <0.001) but independent of gender (correlation coefficient -0.002-0.04, all >0.05). In all eyes, IOP could be lowered to the normal range with topical medication, without development of glaucomatous optic nerve head changes. ·CONCLUSION: Elevated IOP after 4mg IVTA injection is common and patients should be monitored beyond 6 months post-injection. In all the cases, IOP can be normalized by topical medication. Patients with high baseline IOP, diabetic retinopathy, and younger age should be carefully monitored for an elevated IOP.     

A trial of topical prednisolone acetate before intravitreal triamcinolone acetonide decreases intraocular pressure spikes

Objective: To compare adverse intraocular pressure (IOP) spikes in patients receiving intravitreal triamcinolone acetonide (IVTA) in 2 cohorts: (i) patients who underwent a topical prednisolone acetate trial (PAT) without incurring a short-term IOP rise, and (ii) control patients who did not undergo a PAT.Design: Retrospective cohort study.Participants: Charts of all patients who underwent any intravitreal injection during the study period were reviewed (n = 1150).Methods: Patients in the PAT group received a 6-week course of prednisolone acetate 1% 4 times per day and had an IOP that did not rise above 25 mm Hg or above 8 mm Hg over the IOP in the contralateral eye. Patients undergoing a PAT and having a short-term IOP rise were not studied. Control patients did not receive a PAT. All patients received 12-20 mg of IVTA. Patients were followed for a minimum of 6 weeks and follow-up lasted for I year or until intraocular surgery or another IVTA injection was performed.Results: There were 97 patients in the PAT cohort and 75 control patients. Patients in the PAT cohort had a lower proportional rise between maximum IOP and baseline (43%) compared with controls (64%) (p = 0.035). Patients in the PAT group also had a lower risk of incurring a 40% (p = 0.05), 60% (p = 0.0I8), and 100% (p = 0.045) increase in maximum IOP (vs baseline) compared with controls and were less likely to require glaucoma filtration surgery (p = 0.035).Conclusions: Patients undergoing a PAT who did not have a subsequent short-term IOP rise had a lower risk of severe IOP spikes after IVTA compared with those patients receiving IVTA but not having undergone a PAT.     

Complications of intravitreal triamcinolone acetonide for macular edema and predictive factors for intraocular pressure elevation

AIM: To investigate the complications of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema, and to determine the risk factors for intraocular pressure (IOP) elevation. METHODS: Charts of patients with macular edema secondary to branch retinal vein occlusion (BRVO), diabetic retinopathy and uveitis who had received IVTA injections were reviewed to document its complications. IOP elevation was defined as a pressure of ≥24mmHg at some point during follow-up. Multivariate logistic regression analysis was performed to characterize baseline risk factors for this elevation. RESULTS: The study included 111 eyes of 65 female and 46 male patients with a mean follow-up of (11.6±5.1) months. Of the 111 eyes, 52 (46.8%) had macular edema secondary to BRVO, 44 (39.6%) had clinically significant diabetic macular edema (CSDME) and 15 (13.5%) had non-infectious uveitis with macular edema. IOP was recorded ≥ 24mmHg in 38 eyes (34.2%) during the follow-up. Higher baseline IOP (P=0.022), younger age (P=0.003), and male gender (P=0.014) were significant risk factors for IOP elevation after IVTA injection. Eyes with prior vitrectomy were less likely to have IOP elevation (P=0.054). Two eyes (5.2% of eyes with increased IOP) underwent trabeculectomy, and 9 eyes (16.3% of the phakic eyes) necessitated cataract surgery. Other complications included branch vein occlusion (1.8%), sterile endophthalmitis (0.9%) and pseudohypopyon (0.9%). CONCLUSION: IVTA has side effects with IOP elevation and cataract formation being the two most common. A subset of patients is more prone to developing increased IOP following IVTA, namely, younger male patients with higher baseline IOP.     

Efficacy and complications of intravitreal injection of triamcinolone acetonide for refractory cystoid macular edema associated with intraocular inflammation

Purpose  To assess the effects and complications of intravitreal injection of triamcinolone acetonide (IVTA) for posterior sub-Tenon injection of triamcinolone acetonide (PSTA)-resistant cystoid macular edema (CME) with intraocular inflammation. Methods  Medical records of eight eyes of six patients with PSTA-resistant CME were retrospectively examined. Each eye received a 4-mg IVTA, and an additional injection was performed when CME recurred. Visual acuity as logarithm of the minimum angle of resolution (logMAR), intraocular pressure (IOP), and central macular thickness (CMT) were assessed before and after each treatment. Results  CME improved in six eyes (75%) with mean visual acuity recovering from 0.56 ± 0.29 to 0.41 ± 0.195 (logMAR, P = 0.13) and mean CMT decreasing from 470 μm (range, 275–660 μm) to 297 μm (range, 150–697 μm) (P = 0.04) 2 months after the initial IVTA. CME recurred an average of 9 months (range, 5–11 months) after IVTA. A higher dose (16-mg) IVTA was effective for two eyes refractory to repeated 4-mg IVTA. IOP was elevated in two eyes (25%), of which one required filtration surgery (12.5%). In phakic eyes, cataracts progressed and necessitated surgery. Conclusions  IVTA is effective for PSTA-resistant CME with intraocular inflammation, and its efficacy might be dose dependent.     

Safety of intravitreal triamcinolone acetonide:an electrophysiologic and histopathological study in rabbits

AIM

To evaluate the retinal safety of various doses of intravitreal triamcinolone acetonide (TA) in rabbits.

Methods

Thirty New Zealand albino rabbits were divided into five groups (six animals each). In group 1 (control group), each animal received a single intravitreal injection of 0.1mL phosphate buffered saline. In groups 2, 3, 4 and 5, each rabbit received a single intravitreal injection of 4, 8, 16 and 32mg of TA, respectively. Each dose was contained in 0.1mL phosphate buffered saline. Clinical ocular examinations were performed before the injection and on the 1st, 3rd, 10th and 17th post-injection days. A standard dark adapted electroretinogram (ERG) was obtained before injection and on the 3rd, 10th and 17th post-injection days. After 17d, animals were sacrificed and their eyes prepared for pathological examination.

RESULTS

By monitoring ERG as a functional index for the retina, intravitreal injection of 4mg TA showed no significant ERG changes. At doses of 8, 16 and 32, hyper-abnormal responses in a- and b- waves of ERG were detected on the 3rd post-injection day. These changes gradually returned back to normal limits after 17d. Histopathological examination of the retina of all animals showed no pathological changes.

CONCLUSION

High doses of intravitreal TA seemed to have enhancing effects on the retinal function with gradual return to normal limits with no pathological changes detected in examined eyes.     

Safety of intravitreal triamcinolone acetonide:an electrophysiologic and histopathological study in rabbits

AIM: To evaluate the retinal safety of various doses of intravitreal triamcinolone acetonide (TA) in rabbits.Methods: Thirty New Zealand albino rabbits were divided into five groups (six animals each). In group 1 (control group), each animal received a single intravitreal injection of 0.1mL phosphate buffered saline. In groups 2, 3, 4 and 5, each rabbit received a single intravitreal injection of 4, 8, 16 and 32mg of TA, respectively. Each dose was contained in 0.1mL phosphate buffered saline. Clinical ocular examinations were performed before the injection and on the 1st, 3rd, 10th and 17th post-injection days. A standard dark adapted electroretinogram (ERG) was obtained before injection and on the 3rd, 10th and 17th post-injection days. After 17d, animals were sacrificed and their eyes prepared for pathological examination.RESULTS:By monitoring ERG as a functional index for the retina, intravitreal injection of 4mg TA showed no significant ERG changes. At doses of 8, 16 and 32, hyper-abnormal responses in a- and b- waves of ERG were detected on the 3rd post-injection day. These changes gradually returned back to normal limits after 17d. Histopathological examination of the retina of all animals showed no pathological changes.CONCLUSION: High doses of intravitreal TA seemed to have enhancing effects on the retinal function with gradual return to normal limits with no pathological changes detected in examined eyes.