曲安奈德不同给药方式联合光凝对糖尿病性黄斑水肿的疗效观察

目的总结曲安奈德（triamcinolone acetonide，TA）联合黄斑部格栅样光凝对糖尿病性黄斑水肿的疗效．评估TA的两种不同给药方式（玻璃体腔和球周注射）的安全性。方法将48例（50眼）弥漫性黄斑水肿患者随机分为曲安奈德玻璃体腔（0．1ml，4mg）注射组（25眼）和曲安奈德球周（1ml，40mg）注射组（25眼），两组均在注药1个月后行黄斑部格栅样光凝．观察两组注药后第1、第6、第10个月的最佳矫正视力、黄斑水肿的变化、并发症（包括术后短暂高眼压、继发性青光眼、白内障、眼内炎等）的情况。采用χ^2检验比较两组术后3个时间点的最佳矫正视力提高率、黄斑水肿吸收率和并发症发生率。结果全部患者经两种途径给药联合激光治疗后，在不同追踪时间内，视力均有大幅提升。两组在第1、第6、第10个月的最佳矫正视力、黄斑水肿的变化差异均无统计学意义（P〉0．05）。两组10个月内的并发症发生率差异有统计学意义（P〈0．05），球周注射组远低于玻璃体腔注射组。结论曲安奈德（TA）球周注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿，可以达到和球内注射同样的疗效，且并发症少．安全性高。

Curative effect of treatment for diabetic macular edema with triamcinolone acetonide using different methods of injection combined with laser photocoagulation

Objective To determine the curative effect of treatment for diabetic macular edema （DME） with triamcinolone acetonide （TA） combined with laser photocoagulation and to appraise the safety of two different ways to administer triamcinolone acetonide （TA）, peribulbar injection and intravitreous injection. Methotis Forty-eight patients （50 eyes） with diffuse diabetic macular edema were randomly divided into two groups： twenty-five eyes were treated with an intravitreous injection of triamcinolone acetonide （IVTA） （4 mg/0.1 ml）, and another twenty-five were treated with a peribulbar injection of triamcinolone acetonide （IPTA） （40 mg/1 ml）. Laser grid photocoagnlation was used to evaluate all of the patients after one month. Best corrected visual acuity （BCVA）, the change in macular edema and the incidence of complications such as post -treatment transient ocular hypertension, secondary glaucoma, endophthalmitis, etc., were observed and measured at one month, six months and ten months. The χ^2 test was used to compare the improvements in best corrected visual acuity （BCVA）, the absorbance of macular edema and the incidence of complications at the 3 different time periods. Results For the different follow-up times, the visual acuity of all patients improved greatly after treatment with triamcinolone acetonide （TA） using either method of injection combined with laser photocoagulation. There was no statistically significant difference between the two groups in the change of BCVA and macular edema （P〉0.05）; but the difference in the incidence of complications between the two groups showed a statistically significant difference （P〈0.05）. Conclusion A peribulbar injection of TA combined with laser grid photocoagulation has the same curative effect as IVTA, and they are a safe and effective therapy for diabetic macular edema with few complications.