甲强龙联合地塞米松交替球周注射治疗脉络膜脱离型视网膜脱离

目的　评价甲强龙联合地塞米松交替球周注射在玻璃体切割术治疗脉络膜脱离型视网膜脱离中的疗效。方法　回顾性分析我科２０１２年１月至２０１３年１２月收治的临床确诊为脉络膜脱离型视网膜脱离的患者共４６例４６眼。按糖皮质激素的给药途径，分为静脉组与球周组各２３例２３眼，均行玻璃体切除＋硅油充填术，术后随访１２个月以上。对比两组手术前后最佳矫正视力、眼压、术前糖皮质激素使用时间、不良反应发生率、视网膜脱离一次手术复位率、视网膜脱离复发率等。结果　静脉组与球周组患者入院时眼压分别为（６．７４±２．３３）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）和（６．９６±１．８８）ｍｍＨｇ，使用糖皮质激素后术前眼压分别为（９．３４±１．５０）ｍｍＨｇ和（９．４３±１．０８）ｍｍＨｇ；最佳矫正视力入院时分别为２．０７±０．１４和２．２３±０．１６，出院时分别为２．０２±０．１７和２．０３±０．１４，两组组内比较差异均有统计学意义（均为Ｐ＜０．０５），而组间比较差异均无统计学意义（均为Ｐ＞０．０５）。术后１２个月内静脉组与球周组一次性视网膜脱离复位例数分别为１９例和２１例、视网膜脱离复发例数分别为４例和２例，差异均无统计学意义（均为Ｐ＞０．０５）；而两组在术前糖皮质激素使用时间，静脉组为（５．３５±０．１２）ｄ、球周组为（４．０４±０．３８）ｄ，差异有统计学意义（ｔ＝２．３１，Ｐ＝０．０３）；糖皮质激素使用不良反应，静脉组为６例、球周组为０例，差异有统计学意义（χ２＝６．９，Ｐ＝０．００９）。结论　甲强龙联合地塞米松交替球周注射是一种玻璃体切割术治疗脉络膜脱离型视网膜脱离的安全有效的方法。

Alternating peribulbar injection of methylprednisolone and dexamethasone for combined choroidal detachment and retinal detachment

Objective To evaluate curative effects of alternating peribulbar injection of methylprednisolone and dexamethasone in vitrectomy for choriodal detachment and retinal detachment. Methods Retrospective analysis was performed on 46 cases (46 eyes) of patients who were definitely diagnosed as choriodal detachment and retinal detachment . and accepted treatment in our department from January 2012 to December 2013. The patients were divided into two groups , namely vein group and peribulbar group according to administration route of glucocorticoid.23 cases in each group. The vitrectomy and silicone oil filling operation was applied for both groups and follow-up treatment was performed for more than six months. The preoperative and postoperative best corrected visual acuity , intraocular pressure variation, preoperative glucocorticoid applying time.occurrence rate of adverse reaction.one-time surgical reduction rate of retinal detachment, recurrence of retinal detachment were analyzed in the two groups. Results The intraocular pressure in vein group and peribulbar group at being admitted to hospital were ( 6. 74 +2. 33) mmHg ( I kPa = 7. 5 mmHg) and ( 6. 96 + 1. 88 ) mmHg , respectively, the preoperative intraocular pressure after applying glucocorticoid were ( 9. 34 + 1. 50) mmHg and ( 9. 43 + 1. 08 ) mmHg , respectively ; The best corrected visual acuity at being admitted to hospital were 2. 07 + 0. 14 and 2. 23 + 0. 16 , respectively , and were 2. 02 + 0. 17 and l. 03 + 0. 14 when discharged from the hospital, there were statistical differences between intra-groups(P < 0. 05 ) ,while the difference among groups was not statistically sigruficant(P > 0. 05 ) . The one-time retinal detachment reduction cases of vein group and peribulbar group within 12 months were 19 and 21 , respectively. The reduction cases of retinal detachment were 4 and 2 , respectively. The difference was not statistically significant(P > 0. 05 ) . The applying time of preoperative glucocorticoid in the vein group and peribulbar group were ( 5. 35 + 0. 12 ) days and ( 4. 04 + 0. 38 ) days ( t = 2. 31 ,P = 0. 03 ) . The adverse reaction of glucocorticoid application in the vein group and peribulbar group were 6 cases and o case(X2 = 6. 9 ,P = 0. 009) . Conclusion Alternating peribulbar injection of methylprednisolone and dexamethasone is a safe and effective therapy method in vitrectomy for choriodal detachment and retinal detachment.