曲安奈德玻璃体腔注射治疗视网膜静脉阻塞和糖尿病视网膜病变继发黄斑水肿分析

目的 观察玻璃体腔注射曲安奈德(TA)治疗视网膜静脉阻塞(RVO)继发黄斑水肿和糖尿病性黄斑水肿的疗效以及二者疗效比较.方法 对经间接检眼镜、荧光素眼底血管造影(FFA)以及光学相干断层扫描(OCT)检查确诊的RVO继发黄斑水肿患者91例91只眼,其中中央视网膜静脉阻塞(CR-VO)55只眼(缺血型13只眼,非缺血型42只眼),分支视网膜静脉阻塞(BRVO)36只眼(缺血型10只眼,非缺血26眼).糖尿病性黄斑水肿患者67例73只眼,非增殖性糖尿病视网膜病变(PPDR)17只眼,增殖性糖尿病视网膜病变(PDR)56只眼,行TA玻璃体腔注射,治疗后随访3月至1年,对比分析术前术后的视力、眼底、FFA表现,观察OCT显示黄斑水肿高度.结果 最终随访RVO组视力提高者48只眼(52.7%),视力不变者39只眼(42.9%),视力下降者4只眼(4.40%).OCT形态恢复正常者50只眼(54.9%),改善者27只眼(29.7%),无改善者14只眼(15.4%).DR组视力提高者25(34.2%)只眼,,视力不变者45只眼(61.6%),视力下降者3只眼(4.11%).OCT形态恢复正常者24只眼(32.9%),改善者22只眼(30.1%),无改善者27只眼(37.0%).两组有效率行统计学分析,有显著性差异.RVO组24只眼术后出现一过性眼压升高,一眼白内障,一眼眼内炎,8只眼2次注射.DR组14眼术后出现一过性眼压升高,2只眼白内障,9只眼2次注射.结论 玻璃体腔注射TA是一种安全有效的治疗视网膜静脉阻塞继发黄斑水肿和糖尿病性黄斑水肿的方法,治疗视网膜静脉阻塞继发黄斑水肿的疗效好于糖尿病性黄斑水肿.

Comparision of intravitreal triamcinolone acetonide for macular edema secondary to retinal vein occlusion and diabetic retinopathy

Objective To observe the comparison of the therapeutic efficacy of intravitreal of triamcinolone acetonide (TA) for macular edema caused by retinal vein occlusion (RVO) and diabetic retinopathy (DR). Methods TA was injected inttravitreally in 91 eyes of 91 patients with macular edema secondary to RVO and 73 eyes of 67 patients secondary to DR determined by indirect ophthalmoscope, fundus fluorescent angiography (FFA) and optic coherence tomography (OCT). Among the RVO patients, CRVO were 55 eyes (ischemic type was 11 eyes, and 42 eyes were non-ischemic type). BRVO were 36 eyes (ischemic type was 10 eyes, and 26 eyes were non-ischemic type). Among the DR patients, pre-proliferative diabetic retinopathy (PPDR) were 17 eyes and proliferative diabetic retinopathy (PDR) were 56 eyes. The visual acuity, fundus findings, FFA and the macular thickness under the OCT were recorded and analyzed prior to operation and after operation. Follow-up time was 3 months to 1 years. Results In the group of RVO, visual acuity was improved at the end of follow-up in 48 (52.7%) eyes and decreased or unchanged in 4 (4.40%) eyes and 39 (42.9%) eyes, respectively. 50 (54.9%) eyes showed normal macular thickness after injection of TA on OCT. Improved fundus appearance was seen in 27 (29.7%) eyes on OCT. The fundus was unchanged or even worse in 14 (15.4%) eyes on OCT at the last visit. In the group of DR, visual acuity was improved at the end of follow-up in 25 (34.2%) eyes and decreased or unchanged in 3 (4.11%) eyes and 45 (61.6%) eyes, respectively. 24 (32.9%) eyes showed normal macular thickness after injection of TA on OCT. Improved fundus appearance was seen in 22 (30.1%) eyes on OCT. The fundus was unchanged or even worse in 27 (37.0%) eyes on OCT at the last visit. The difference of two groups was significant. In the group of RVO, intraocular pressure was elevated in 24 eyes. Cataract was in 1 eye and endophthalmitis in 1 eye. 8 eyes were injected two times. In the group of DR, intraocular pressure was elevated in 14 eyes. Cataract was in 2 eyes. 9 eyes were injected two times. Conclusions Intravitreal injection of TA is a safe and effective method to the treatment of macular edema secondary to RVO and DR. The therapeutic efficacy for RVO is better than for DR.