早期硅油填充联合曲安奈德治疗增生性糖尿病视网膜病变

目的 观察玻璃体手术中使用曲安奈德和早期硅油填充治疗增生性糖尿病视网膜病变的疗效.方法 增生性糖尿病视网膜病变,52例(52眼),行经平坦部玻璃体切除手术.术中使用曲安奈德标识病变组织,将其彻底切除.玻璃体腔内填充硅油.术前最佳矫正视力为0.05.术后随访8个月,观察视力、眼压、视网膜出血和增生情况,并及时补充激光治疗.治疗和随访期内,要求血糖控制在7.0 mmol/L以下的平稳状态.结果 术后8个月,无继发性青光眼或严重增生性反应.观察期内糖尿病视网膜病变无明显再进展表现.结论 在玻璃体切除手术中使用曲安奈德和早期硅油填充,能够有效减少术后并发症,并为及时补充激光治疗提供有利条件,较好的控制糖尿病视网膜病变的进展.     

药物辅助下玻璃体切除术治疗增生性糖尿病视网膜病变

目的:探讨曲安奈德联合Bevacizumab(Avastin)辅助玻璃体切除术治疗严重糖尿病视网膜病变的临床应用价值。方法:回顾性分析药物辅助下玻璃体切除治疗的严重增生性糖尿病视网膜病变13例15眼,15眼均于术前3~14d行Bevacizumab(Avastin)1.25mg/0.05mL玻璃体腔注射,常规玻璃体切除术中使用曲安奈德辅助切除残留的玻璃体皮质、视网膜增殖膜,其中9例合并牵拉性视网膜脱离及黄斑水肿者硅油填充并留置4mg/0.1mL曲安奈德,4眼未使用硅油填充眼因合并黄斑水肿大量硬性渗出予曲安奈德留置。2眼单纯玻璃体积血者未注射曲安奈德。结果:除1例玻璃体腔注射Avastin 3d后术中出血较多特别是在剥离纤维新生血管膜过程中,其余病例术中出血很少,并能迅速自凝。联合曲安奈德辅助可清晰地辨别残留皮质、视网膜前膜甚至内界膜,黄斑水肿术后明显减轻,所有病例术后炎症反应轻,眼压控制良好,硅油眼中留置曲安奈德无明显并发症。结论:严重的增生性糖尿病视网膜病变玻璃体切除术前7~14d玻璃体腔注射Bevacizumab(Avastin),明显减少术中出血,术中使用曲安奈德辅助可视性良好。术毕留置4mg曲安奈德可有效减轻黄斑水肿及术后反应。     

玻璃体切割术后注入曲安奈德辅助治疗增生性玻璃体视网膜病变的初步观察

曲安奈德(TA)近年来越来越多地应用于玻璃体手术辅助治疗各种玻璃体视网膜疾病,尤其是增生性玻璃体视网膜病变(PVR)与增生性糖尿病视网膜病变(PDR),显示出了良好的治疗效果与广泛的应用前景[1,2].我们回顾分析了22例因PVR C级以上而行玻璃体切割术且于手术结束时行玻璃体内注射TA治疗患者的临床资料,现将结果报告如下.     

玻璃体切割术后注入曲安奈德辅助治疗增生性 玻璃体视网膜病变的初步观察

曲安奈德(TA)近年来越来越多地应用于玻璃体手术辅助治疗各种玻璃体视网膜疾病，尤其是增生性玻璃体视网膜病变(PVR)与增生性糖尿病视网膜病变(PDR)，显示出了良好的治疗效果与广泛的应用前景。我们回顾分析了22例因PVRC级以上而行玻璃体切割术且于手术结束时行玻璃体内注射TA治疗患者的临床资料，现将结果报告如下。     

曲安奈德在眼科的应用

玻璃体腔注射曲安奈德可治疗多种原因引起的黄斑水肿,减轻炎症反应、抑制增生性玻璃体视网膜病变的发生和减少眼内新生血管的形成,并可辅助玻璃体切除术。可出现术后眼压升高、白内障和眼内炎等并发症。     

糖尿病视网膜病变玻璃体手术中应用曲安奈德的并发症观察

目的:讨论糖尿病视网膜病变玻璃体手术中应用曲安奈德的并发症.方法:回顾性分析2005-02/2007-01在我院进行的18例玻璃体手术中应用曲安奈德的增生性糖尿病视网膜病变患者手术后的反应.结果:手术后随访3～6(平均4.6)mo,出现高眼压2例;假性前房积脓1例;手术后玻璃体再出血3例;3例视网膜表面及黄斑区曲安奈德沉积.结论:手术后出现的假性前房积脓、视网膜表面及黄斑区曲安奈德沉积等并发症可不用特殊处理,自行吸收.术后出现的高眼压可通过降眼压药物治疗.手术后出现的玻璃体再出血可在药物不能吸收时通过再次手术治疗.     

曲安奈德在眼科的应用

玻璃体腔注射曲安奈德可治疗多种原因引起的黄斑水肿，减轻炎症反应、抑制增生性玻璃体视网膜病变的发生和减少眼内新生血管的形成，并可辅助玻璃体切除术。可出现术后眼压升高、白内障和眼内炎等并发症。     

糖尿病视网膜病变玻璃体手术中应用曲安奈德的并发症观察

目的讨论糖尿病视网膜病变玻璃体手术中应用曲安奈德的并发症。方法回顾性分析2005年2月至2007年2月在我院进行的20例玻璃体手术中应用曲安奈德的增生性糖尿病视网膜病变患者手术后的反应。结果手术后随访（3-6）m（平均4.7m）,出现高眼压2例,占10%;假性前房积脓1例,占5%;手术后玻璃体再出血3例,占15%;3例视网膜表面及黄斑区曲安奈德沉积,占15%。结论手术后出现的假性前房积脓、视网膜表面及黄斑区曲安奈德沉积等并发症可不用特殊处理,自行吸收。术后出现的高眼压可通过降眼压药物治疗。手术后出现的玻璃体再出血可在药物不能吸收时通过再次手术治疗。     

玻璃体腔内注射曲安奈德的应用进展

曲安奈德(triamcinoloneacetonide,TA)又称丙酮氟羟泼泥松龙等,最初主要应用于呼吸道及皮肤系统的各种变态反应性疾病和风湿性、类风湿关节炎。20世纪80年代始用于眼科,近年来,为达到药物在眼内局部高浓度及长时间持续作用,临床采用玻璃体腔内注射曲安奈德,以辅助一些内眼手术及控制视网膜、葡萄膜和视神经的炎症,抑制增生性玻璃体视网膜病变(proliferativevitreor-etinopathy,PVR)和视网膜、脉络膜及虹膜的新生血管形成,并治疗各种病变所致的黄斑水肿等,临床观察疗效良好,且无明显的视网膜毒副作用。一、曲安奈德的临床应用曲安奈德玻璃…     

玻璃体切除术中应用曲安奈德治疗增生性糖尿病视网膜病变

增生性糖尿病性视网膜病变是糖尿病患者致盲的主要原因。随着糖尿病发病率的逐年上升也在逐年增加。玻璃体切除是其治疗的主要手段。故在玻璃体切除手术中改善手术方法,快而全的切除掉玻璃体显得十分重要。我们于2007年12月至2009年7月在玻璃体切除术术中应用曲安奈德（TA）行残存玻璃体及增生膜染色治疗增生性糖尿病性视网膜病变54例（58眼）,起到了缩短手术时间,减少术后并发症的效果。现报告如下：     

Regression of Optic Nerve Head Neovascularization in Proliferative Diabetic Retinopathy After Intravitreal Triamcinolone: Regression of Diabetic Optic Disc Neovascularization After Intravitreal Triamcinolone

The aim of this study is to report the clinical outcome of a diabetic patient with optic nerve head neovascularization treated with an intravitreal injection of triamcinolone acetonide. A 52-year-old patient presented with clinically significant diffuse macular edema and optic nerve head neovascularization due to proliferative diabetic retinopathy in her right eye. Despite grid laser photocoagulation in the macular region macular edema progressed and visual acuity declined. The patient received a single intravitreal injection of 4 mg triamcinolone acetonide with topical anesthesia. After injection of triamcinolone acetonide visual acuity increased and macular edema decreased. Furthermore optic nerve head neovascularization had markedly regressed. No complication was observed during follow-up period. Intravitreal injection of triamcinolone acetonide may be useful for treatment of optic nerve head neovascularization in patients with proliferative diabetic retinopathy.     

Intravitreal triamcinolone acetonide as an additional tool in pars plana vitrectomy for proliferative diabetic retinopathy

PURPOSE: To evaluate the safety and efficacy of intravitreal injections of crystalline triamcinolone acetonide as an adjunctive procedure in pars plana vitrectomy for proliferative diabetic retinopathy. METHODS: This nonrandomized comparative study included 30 patients (32 eyes) who underwent standardized pars plana vitrectomy for treatment of proliferative diabetic retinopathy and who received an intravitreal injection of 25 mg triamcinolone acetonide at the end of surgery. Mean follow-up time was 5.60 +/- 5.14 months. The study group was compared with a control group (32 eyes) matched with the study group for preoperative and intraoperative parameters and who underwent pars plana vitrectomy for proliferative diabetic retinopathy without intravitreal injection of triamcinolone acetonide. RESULTS: The study group and the control group did not vary significantly in frequency of postoperative retinal detachment, re-pars plana vitrectomy, or postoperative enucleation or phthisis bulbi, or in best postoperative visual acuity, visual acuity at end of the study, or gain in visual acuity. CONCLUSIONS: In this pilot study, the study group with pars plana vitrectomy and intravitreal triamcinolone acetonide injection compared with the nonrandomized control group without intravitreal triamcinolone acetonide injection did not show a higher than usual rate of postoperative complications. As a corollary, however, the data do not suggest the adjunct use of 25 mg intravitreal triamcinolone acetonide combined with pars plana vitrectomy as treatment of proliferative diabetic retinopathy.     

Persistent unsealed sclerotomy after intravitreal injection of triamcinolone acetonide with a 30-gauge needle

We report the case of a persistent unsealed sclerotomy following intravitreous injection of triamcinolone through the pars plana using a 30-gauge needle. The injection was made for the treatment of diabetic macular edema. The eye had been treated 9 months before by pars plana vitrectomy and pan retinal photocoagulation for vitreous hemorrhage complicating diabetic proliferative retinopathy. Five days after injection, the patient presented with severe hypotony and chemosis. A conjunctival Seidel was noted at the site of injection. Surgical exploration revealed a punctiform scleral wound without vitreous incarceration, which was closed with a 10-0 nylon suture. No other complication occurred. Our observation highlights that in spite of its simplicity, intravitreous injection of triamcinolone is an invasive procedure that requires rigorous follow-up. In vitrectomized eyes, the higher risk of unsealed scleral wound after intravitreous injection should encourage this injection to be made in a site where no sclerotomy usually occurs. The 6'o-clock meridian could be a good location.     

曲安奈德眼内注射的并发症不容忽视

眼内注射曲安奈德治疗由糖尿病视网膜病变、葡萄膜炎、渗出型老年黄斑变性或视网膜静脉阻塞等引起的黄斑水肿、慢性低眼压等疾病的有效性已得到公认，其临床应用日趋普遍，在充分肯定其治疗作用的同时，曲安奈德的副作用及并发症——继发性青光眼、并发性白内障、眼内炎、视网膜脱离及玻璃体积血等这些已经报道的及尚未认识到的并发症必须引起临床医师的高度警惕及重视。     

A case of herpetic keratitis after intravitreal triamcinolone injection

PURPOSE: We report a case of herpetic epithelial keratitis that developed after intravitreal triamcinolone acetonide injection. METHODS: An 81-year-old man with diabetes with severe nonproliferative diabetic retinopathy and diffuse macular edema in both eyes received bilateral intravitreal injections of 0.4 mg/0.1 mL of triamcinolone acetonide. RESULTS: Eighteen days after the injections, the patient presented with redness, tearing, foreign body sensation, and decreased visual acuity in the right eye. The cornea showed dendriform ulcers that exhibited positive fluorescein staining. Diagnosis for herpes simplex epithelial keratitis was made, and topical acyclovir ointment therapy was initiated. The epithelial lesions healed after 7 days of therapy. CONCLUSIONS: Herpes simplex epithelial keratitis can be a possible complication of intravitreal triamcinolone acetonide injection. The course and response to conventional therapy was no different from that of the classical course of the disease.     

眼底激光联合玻璃体腔注药治疗合并黄斑水肿的糖尿病性视网膜病变的临床观察

目的:探讨全视网膜光凝术联合玻璃体腔注药术治疗合并黄斑水肿的糖尿病性视网膜病变的效果。方法:应用532半导体绿激光治疗机对视网膜病变达Ⅲ期以上同时合并黄斑水肿的糖尿病性视网膜病变患者,行全视网膜光凝术,术后1wk行曲安奈德玻璃体腔注射。结果:治疗后241眼中视力提高及无下降者218眼,有效率占90.5%,视力下降及玻璃体出血23眼,占9.5%,治疗前后有非常显著的临床意义。结论:全视网膜光凝术联合玻璃体腔注药术治疗合并黄斑水肿的糖尿病性视网膜病变安全有效。     

Combined intravitreal injection of triamcinolone acetonide and panretinal photocoagulation for concomitant diabetic macular edema and proliferative diabetic retinopathy

PURPOSE: To present our results of intravitreal injection of triamcinolone acetonide (IVTA) combined with panretinal photocoagulation (PRP) for patients with concomitant clinically significant diabetic macular edema and proliferative diabetic retinopathy. METHODS: Charts of patients undergoing combined IVTA and PRP were reviewed. Outcome measures included visual acuity, presence of macular edema, and response of proliferative disease to laser photocoagulation. RESULTS: Four patients were included in this study. All patients maintained stable visual acuity during the treatment period. All patients had improvement in the amount of macular edema, despite the application of PRP, as well as complete regression of their proliferative disease. There were no short-term complications associated with IVTA or PRP. CONCLUSION: Combination treatment with IVTA and PRP may provide benefit in patients with diffuse diabetic macular edema who require urgent PRP for proliferative diabetic retinopathy by preventing exacerbation of macular edema.     

曲安奈德不同给药方式联合光凝对糖尿病性黄斑水肿的疗效观察

目的总结曲安奈德（triamcinolone acetonide,TA）联合黄斑部格栅样光凝对糖尿病性黄斑水肿的疗效．评估TA的两种不同给药方式（玻璃体腔和球周注射）的安全性。方法将48例（50眼）弥漫性黄斑水肿患者随机分为曲安奈德玻璃体腔（0．1ml,4mg）注射组（25眼）和曲安奈德球周（1ml,40mg）注射组（25眼）,两组均在注药1个月后行黄斑部格栅样光凝．观察两组注药后第1、第6、第10个月的最佳矫正视力、黄斑水肿的变化、并发症（包括术后短暂高眼压、继发性青光眼、白内障、眼内炎等）的情况。采用χ^2检验比较两组术后3个时间点的最佳矫正视力提高率、黄斑水肿吸收率和并发症发生率。结果全部患者经两种途径给药联合激光治疗后,在不同追踪时间内,视力均有大幅提升。两组在第1、第6、第10个月的最佳矫正视力、黄斑水肿的变化差异均无统计学意义（P〉0．05）。两组10个月内的并发症发生率差异有统计学意义（P〈0．05）,球周注射组远低于玻璃体腔注射组。结论曲安奈德（TA）球周注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿,可以达到和球内注射同样的疗效,且并发症少．安全性高。     

Intravitreal triamcinolone acetonide for florid proliferative diabetic retinopathy

Background The spectrum of ocular indications in which intravitreal injections of triamcinolone acetonide may be therapeutically useful has recently been expanding.Methods Prospective clinical interventional case study in a young adult male with florid proliferative diabetic retinopathy (FPDR).Results A greater reduction of retinal thickening and fluorescein leakage from retinal new vessels was observed in the right eye after intravitreal injection of triamcinolone followed by scatter panretinal photocoagulation (PKP) than in the left eye treated only by laser.Conclusion Intravitreal injection of triamcinolone acetonide may be a useful adjunct to scatter panretinal photocoagulation for FPDR.