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。

Effects of intravitreal triamcinolone acetonide for diffuse diabetic macular edema

AIM:To study the effects of intravitreal triamcinolone acetonide(IVTA)combined with macular laser photocoagulation for diffuse diabetic macular edema(DME).METHODS:Thirty-five patients(37 eyes)with diffuse DME were randomized into 2 groups:Laser group(20 eyes)was applied macular grid photocoagulation 1 month after IVTA;Control group(17 eyes)underwent only IVTA.The changes of best correct visual acuity(BCVA)and central macular thickness(CMT)in both groups were compared at 1,3 and 6 months after IVTA,respectively.RESULTS:In control group,the BCVA before injection and at 1,3 and 6 months after IVTA were 0.15±0.13,0.28±0.19,0.22±0.14 and 0.17±0.10.There was significant improvement in BCVA at 1,3 months compared with before injection,but had no significant difference between 6 months and before injection.The mean CMT at these time points were 469±136.60μm,231.82±61.02μm,255.12±92.66μm,and 349.06±116.19μm.A statistically significant reduction in CMT could be observed at 1,3 and 6 months after IVTA compared with before injection,but the CMT at 6 months presented a significant increase compared to that at 3 months.In laser group,the BCVA before injection and at 1,3 and 6 months after IVTA were 0.14±0.11,0.27±0.17,0.25±0.15 and 0.23±0.13.The CMT at each time points were 473.33±123.22μm,245.68±74.85μm,257.36±79.44μm and 276.57±99.64μm.There were statistically significant gain in BCVA and reduction in CMT at 1,3 and 6 months after IVTA compared to that before injection.CONCLUSION:The macular laser photocoagulation after IVTA may be considered as an effective treatment for DME.Further follow-up and analysis is required to demonstrate its long term efficacy.