玻璃体腔注射曲安奈德联合激光治疗视网膜黄斑分支静脉阻塞黄斑水肿

目的:观察玻璃体腔注射曲安奈德(triamcinolone ace-tonide,TA)联合激光治疗视网膜黄斑分支静脉阻塞黄斑水肿的临床疗效。方法:将经过视力、眼压、眼底检查、眼底彩色照相、荧光素眼底血管造影(FFA)、光相干断层扫描(OCT)检查确诊的164例164眼视网膜黄斑分支静脉阻塞伴黄斑水肿患者纳入治疗。男90例90眼,女74例74眼,年龄20～80(平均59.7)岁。矫正视力0.02～0.6,logMAR视力为0.778±0.347。病程3d～2a。平均眼压15.22mmHg(1mmHg=0.133kPa)。FFA检查黄斑区晚期均有荧光素蓄积;OCT示平均黄斑中心凹视网膜厚度442.41±74.07μm。表面麻醉下给予4mgTA玻璃体腔注射,2wk后进行黄斑区光凝治疗。治疗后第1,3,6mo随访。结果:164例患者治疗后1,3,6mo的平均logMAR最佳矫正视力(BCVA)分别提高至0.49±0.34,0.44±0.34,0.43±0.33,与治疗前比较,差异均有统计学意义。治疗后6mo视力提高135眼(82.3%),其中视力提高≥2者103眼(62.8%);治疗后1,3,6moFFA检查黄斑区晚期荧光素蓄积均有减轻或消失,治疗后1,3,6mo,OCT检查平均黄斑中心凹视网膜厚度分别为253.99±63.99μm,239.84±53.74μm,234.55±51.32μm;与治疗前比较,差异均有统计学意义。治疗后6mo,黄斑水肿改善者147眼(89.6%)。玻璃体腔注药后3d之内有4眼发生假性眼内炎,观察及治疗后恢复至可行激光治疗,治疗后3mo时有11眼眼压高于正常,用药后均恢复至正常范围。结论:玻璃体腔注射TA联合激光治疗视网膜黄斑分支静脉阻塞引起的黄斑水肿疗效较好,明显提高视力,改善视功能,促使黄斑水肿消退或减轻。

Clinical observation of intravitreous injection of triamcinolone acetonide combined with laser photocoagulation for macular edema of macular branch retinal occlusion

AIM:To evaluate the efficacy of intravitreous injection of triamcinolone acetonide(TA) combined with laser photocoagulation for macular edema of macular branch retinal occlusion(MBRVO). ·METHODS:A total of 164 patients(164 eyes) with MBRVO which was diagnosed by examination of visual acuity,intraocular pressure,ocular fundus,fundus color photography,fundus fluorescein angiography(FFA) and optic coherence tomography(OCT) were underwent intravitreal injection of TA combined with laser photocoagulation.There were 90 males(90 eyes)and 74 femals(74 eyes) in the patients aged from 20 to 80 years old,average 59.7 years old. The best corrected visual acuity(BCVA) was 0.02-0.6,and logMAR was 0.778±0.347.There was obvious dye pooling of fluorescein in macular examined by FFA.The average of retinal thickness of macular foveal was 442.41±74.07μm.Intravitreal injection with 4mg TA was performed under surface anesthesia,and laser photocoagulation was performed after 2 weaks.Patients were followed up 1,3,6 months after the treatment. ·RESULTS:The mean logMAR BCVA was significantly improved to 0.49±0.34,0.44±0.34 and 0.43±0.33 1 month and 3,6 months after treatment respectively,and the differences was statistically significant compared with before.135 eyes(82.3%) had an improved visual acuity,and the BCVA increased 2 lines(0.2 logMAR vision) or better in 103 eyes(62.8%) 6 months after treatment.FFA showed that dye pooling of fluorescein in macular zone had lowed or disappeared 1 month,3 and 6 months after treatment.OCT demonstrated that retinal thickness of macular foveal decreased to 253.99±63.99μm at 1 month,decreased to 239.84±53.74μm at 3 months,and decreased to 234.55±51.32μm at 6 months.And the differences were statistically significant compared with before.There were remarkable resolution of the central retinal edema in 147 eyes(89.6%) 6 months after therapy. pseudo-endophthalmitis occurred in 4 eyes 3 days after Intravitreous injection with triamcinolone acetonide.Patients was observed and cured until the laser treatment was viable. 3 months after treatment,intraocular pressure was higher than normal in 11 eyes ,and they were totally restored to normal after medication. ·CONCLUSION:Intravitreous injection with triamcinolone acetonide(TA) combined with laser photocoagulation is a promising therapeutic method for macular edema of macular branch retinal occlusion.