经皮肤球后注射曲安奈德治疗黄斑水肿的初步临床观察

目的:评价经皮肤球后注射曲安奈德(triamcinolone ace-tonide,TA),治疗多种原因引起的黄斑水肿的疗效及安全性。方法:选择多种原因所致的黄斑水肿患者22眼,其中视网膜静脉阻塞13眼、湿性年龄相关性黄斑变性4眼、糖尿病性视网膜病变3眼,其他原因2眼。入选患者治疗前均行视力、眼压、眼底和黄斑光学相干断层扫描(OCT)检查。确诊后给予球后注射TA40mg,其中有6眼重复给药1次,其间隔时间平均为59.50±7.73d;有2眼重复给药2次,其间隔时间为56d。于用药后1,2,3mo对比观察用药前后的视力、眼压、眼底及OCT检测的黄斑中心凹视网膜厚度变化情况。结果:22眼中除5眼视力无变化外,其余眼视力均有不同程度提高。OCT显示:仅注射1次的14眼给药后1mo时黄斑中心凹平均厚度较治疗前降低248.00±178.66μm与治疗前比较有显著差异(P<0.01)。注射两次的6眼,第1次给药后1mo时黄斑中心凹平均厚度较治疗前降低147.33±148.11μm(P<0.05),第2次用药后1mo时黄斑中心凹平均厚度较治疗前降低389.16±239.06μm(P<0.05);给药3次的2眼治疗前黄斑中心凹平均厚度548μm,第2次用药后1mo时黄斑中心凹平均厚度460.5μm,第3次用药后1d时黄斑中心凹平均厚度394.5μm,由于样本量少未行统计学分析。眼压:仅注射1次的14眼,虽然治疗前与治疗1d时比较平均眼压升高的差值有统计学意义(P<0.05),但眼压均在正常值以内;给药2、3次的眼压均未超过正常值且眼压升高的差值无统计学意义。结论:经皮肤球后注射曲安奈德治疗多种原因引起的黄斑水肿具有一定疗效,并且安全、可操作性强,重复注射可加强疗效且未增加眼压升高的危险。

Clinical observation of trans-skin retrobulbar with triamcinolone acetonide injection for treatment of macular edema

AIM:To evaluate the effect and safety of trans-skin retrobulbar triamcinolone acetonide (TA) injection for the treatment of macular edema due to various causes.·METHODS:Twenty-two eyes macular edema due to various causes were included,of them,13 eyes was due to retinal vein occlusion,4 eyes due to wet age-related macular degeneration,3 eyes due to diabetic retinopathy,and 2 eyes due to other causes.Best-corrected visual acuity,intraocular pressure (IOP),foveal retinal thickness measurement by optical coherence tomography (OCT),and fundus status examinations were done before treatment.A trans-skin retrobulbar TA injection at the dose of 40 mg was administered.Six eyes were repeated once,the average time was 59.50±7.73 days,and 2 eyes were repeated twice with average time 56 days.Best-corrected visual acuity was measured,and central macular thickness was obtained by OCT at each visit (post-treatment 1,2,3 months).Intraocular pressure and fundus status were also evaluated.·RESULTS:Mean best corrected visual acuity improved from baseline at the follow-up intervals except remain unchanged in 5 eyes.The mean central macular thickness,which was obtained 1,2 and 3 months post-treatment,was significantly different from the baseline measurement (P<0.01 for re-injection once in 14 eyes,P<0.05 for re-injection twice in 6 eyes).IOP which was obtained 1 month post-treatment in 14 eyes administered TA once,was different from the baseline measurement (P<0.05),but the raised IOP still in the normal range;while the IOP was no difference in administered TA twice or third times from the baseline measurement.·CONCLUSION:Trans-skin retrobulbar TA injection to treat macular edema due to various causes is an effective,safety,easy handling therapy method,and repeated injection may improve the effect and has no the danger to raised IOP.·