曲安奈德玻璃体腔注射联合激光光凝治疗糖尿病性黄斑水肿24例

目的评价单次玻璃体腔注射曲安奈德（IVTA）联合视网膜光凝对糖尿病黄斑水肿（DME）的治疗效果。方法将DME患者24例（30眼）随机分为单纯光凝组、联合治疗组（光凝联合曲安奈德玻璃体腔注射组），每组15眼。联合治疗组在格栅样光凝前1周经睫状体平坦部玻璃体腔注射曲安奈德4mg。观察治疗前后最佳矫正视力（best corrected visual acuity，BCVA）和光学相干断层扫描检查黄斑中心凹厚度（foveal thickness，FT）。应用SPSS统计软件的配对t检验进行统计学分析。结果术前BCVA分别为0．10±0．09和0．11±0．12，FT分别为（518．1±117．5）μm和（524．9±147．4）μm，两组间差异无统计学意义（分别为P=0．25和P=0．39）。联合组治疗后视力提高和FT改善。术后3、6个月，光凝组和联合治疗组BCVA分别为0．19±0．16和0．23±0．18，0．17±0．13和0．28±0．15；FT分别为（324．1±115．2）μm和（279．4±98．8）μm，（354．1±121．2）μm和（248．4±102．6）μm；两组间差异有统计学意义（P〈0．05和P〈0．01）。随访过程中，联合治疗组中3例出现一过性眼压升高，药物治疗控制；1例白内障进展。结论曲安奈德联合格栅光凝治疗DME较单纯激光光凝治疗能更好地提高视力，减轻黄斑水肿，但远期疗效、水肿复发率及并发症仍需要进一步扩大样本长期随访。

Intravitreal triamcinolone acetonide and laser photocoagulation for diabetic macular edema

Objective To evaluate the clinical outcome of intravitreal triamcinolone acetonide （IVTA） combined with laser photocoagulation for diffuse diabetic macular edema （DME）. Methods Thirty eyes of 24 patients with macular edema were randomly divided into two groups： the simple laser photocoagulation group （ n = 15） and the laser combination with IVTA-photecoagula- tion group （ n = 15）. Eyes in the combination group were subjected to laser photocoagulation one Week after 4 mg IVTA. The best-corrected visual acuity, foveal thickness （FT） （by optical coherence tomography） and postoperative complications were com- pared between the two groups. Results Baseline VA and FT was respectively 0.10 ± 0.09 and 518.1 ± 117.5 pan in the photocoagulation group and 0.11 ± 0.120 and 524.9 ± 147.4 tan in the combination group, which was not statistically significant between the two groups. Visual acuity was improved and FT was reduced in the two groups. BCVA was 0.19 ± 0.16 and 0.23 ± 0.18 at 3 months and 0.17 ±0.13 and 0.28 ± 0.15 at 6 months after treatments, FT was 324.1 ± 115.2 μm and 279.4± 98.8 μm at 3 months and 354.1 ± 121.2μm and 248.4 ± 102.6 μm at 6 months after treatments, for the laser photocoagulation group and combined group, respectively （ P 〈 0.1301 ）. 2 cases had an increased transitory intraecular pressure and were controlled by drugs, and 1 case had cataract progression in the combination group. Conclusion IVTA combined with laser photocoagulation is superior to simple laser photocoagulation in improving VA and reducing FT.