不同剂量曲安奈德前房注射抑制青光眼联合白内障手术后前葡萄膜炎的临床研究

目的观察不同剂量曲安奈德(triamcinolone acetonide,TA)前房注射抑制青光眼联合白内障手术后前葡萄膜炎的安全性和有效性。方法青光眼合并白内障患者88例(88眼),由同一医师进行青光眼联合白内障手术。所有患者随机分为正常对照(NC)组、TA1组、TA2组、TA3组,NC组患者术毕结膜下注射2.5mg地塞米松磷酸钠注射液,通过辅助切口分别给TA1组、TA2组、TA3组患者前房注射TA0.5mg、1.0mg、2.0mg。观察4组患者术后1d、3d、5d最佳矫正视力、前房反应、眼压和角膜内皮细胞计数等。结果术后最佳矫正视力TA2组恢复最佳,术后5d0.4～0.6占12/22(54.6%),>0.8占7/22(31.8%)。术后各时间点TA1组、TA2组、TA3组前房反应明显低于NC组,术后3d、5d差异均有统计学意义(均为P<0.05)。NC组、TA1组、TA2组、TA3组术后5d眼压分别为(14.69±5.13)mmHg(1kPa=7.5mmHg)、(12.78±4.89)mmHg、(13.21±4.63)mmHg、(14.16±5.33)mmHg,4组间差异无统计学意义(F=0.823,P=0.485)。术后所有患者角膜内皮细胞计数都在正常范围,4组间角膜内皮细胞计数差异无统计学意义。结论青光眼联合白内障手术中前房内注射0.5mg、1.0mg、2.0mg不同剂量的TA,术后都能极好地抑制前房反应,无明显不良反应,但注射1.0mgTA能够在术后短期取得更好的最佳矫正视力。

Intracameral different dosage triamcinolone acetonide for anterior uveitis after cataract combined with anti-glaucoma surgery

Objective To evaluate the safety and effectiveness of intracameral different dosage triamcinolone acetonide(TA) for anterior uveitis after cataract combined with anti-glaucoma surgery.Methods Eighty-eight patients(88 eyes) with glaucoma and cataract were performed trabeculectomy combined with cataract surgery.All patients were randomly divided into normal control group(NC),TA1 group,TA2 group,TA3 group.After operation,NC group were received the subconjunctival injection of 2.5 mg dexamethasone sodium phosphate,and TA1 group,TA2 group,TA3 group were respectively performed anterior chamber injections of TA 0.5 mg,1.0 mg,2.0 mg.The best corrected visual acuity(BCVA),anterior chamber reaction,intraocular pressure and corneal endothelial count were observed and compared among all groups at1 day,3 days,5 days after operation.Results The recovery of postoperative BCVA in TA2 group was the fastest,which at postoperative 5 days was from 0.4 to 0.6 in 12 eyes(54.6%),more than 0.8 in 7 eyes(31.8%).Anterior chamber reaction of TA1 group,TA2 group and TA3 group at postoperative each time point was significantly lower than that of NC group,there were statistical differences at postoperative 3 days and 5 days(both P<0.05).The intraocular pressure of NC group,TA1 group,TA2 group and TA3 group at postoperative 5 days were(14.69±5.13) mmHg(1 kPa=7.5 mmHg),(12.78±4.89) mmHg,(13.21±4.63) mmHg and(14.16±5.33) mmHg respectively,there was no statistical difference among four groups(F=0.823,P=0.485).Postoperative corneal endothelial counts were all within normal range,there was no statistical difference among four groups.Conclusion Intracameral different dosage TA(0.5 mg,1.0 mg,2.0 mg) after cataract combined with anti-glaucoma surgery can be greatly suppressed postoperative anterior chamber reaction.No significant adverse reaction is found after operation,but the patients of intracameral 1.0 mg TA get better BCVA in the short term.