曲安奈德玻璃体腔重复注射治疗视网膜中央静脉阻塞性黄斑水肿的疗效评价

目的:研究玻璃体腔重复注射曲安奈德(intravitreal triam-cinolone,IVTA)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)引起的黄斑水肿的临床效果。方法:研究对象为17例17眼接受IVTA(4mg)单次及重复注射的CRVO性黄斑水肿患者,均为人工晶状体眼或无晶状体眼(男/女=10/7),重复注射时间均为首次注射后16wk。在术前及术后1,2,3,4mo,分别测量单次注射组和重复注射组最佳矫正视力(best-corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)。采用配对-t检验对两组结果进行统计学分析。结果:单次注射组与重复注射组术前BCVA和CFT相比无显著差异。两次注射后BCVA及CFT均有短暂提高,虽然在随访结束时两组的BCVA及CFT与注射前仍有显著差异(单次注射组:P=0.032,0.049,重复注射组:P=0.01,0.008)。但重复注射组每个时间点BCVA均显著低于单次注射组(P值分别是0.043,0.011,0.010和0.012)。在注射后1,2,3mo,重复注射组CFT均显著高于单次注射组(P值分别是0.040,0.015和0.025)。单次及重复注射后眼压最高水平分别是20.0mmHg(SD2.06)和18.56mmHg(SD3.65),两者之间无显著性差异(P=0.467)。在随访期间未发现其它明显的副作用。结论:在治疗视网膜中央静脉阻塞引起的黄斑水肿时,4mgIVTA重复注射效果要差于单次注射。

Effects of repeated injection of intravitreal triamcinolone on macular edema in central retinal vein occlusion

AIM: To investigate the effectiveness of repeated injection of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular edema due to central retinal vein occlusion (CRVO). ·METHODS: Seventeen pseudophakic or aphakic eyes of 17 patients (10 males and 7 females) with macular edema due to CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose.Examin-ation included measurement of best-corrected visual acuity (BCVA) for distance, central foveal thickness (CFT) measurement by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired-t test. Side effects were monitored. ·RESULTS: BCVA and CFT were not significantly different before initial and repeat injection. Transient improvements of BCVA and CFT were achieved after both injections. Although BCVA and CFT in the end of follow-up were still significantly different from that of pre-injection in the same group (P=0.032, 0.049 in the initial injection group, and 0.001, 0.008 in the repeat injection group, respectively), but compared with the initial injection, the BCVA was significantly worse at every time points (P=0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection and so were CFT at 1, 2, and 3 months post-injection (P= 0.040, 0.015 and 0.025, respe-ctively). The maximum mean IOP achieved was 20.00 (SD 2.06) mmHg and 18.56 (3.65) mmHg after the first and repeat injections, respectively, and they were not significantly different (P=0.467). No other significant adverse events were noted during the study. ·CONCLUSION: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular edema from CRVO.