玻璃体腔内注射曲安奈德治疗糖尿病性黄斑水肿的临床疗效观察

目的评价玻璃体内注射曲安奈德（TA）治疗糖尿病性黄斑水肿的疗效与安全性。方法回顾性分析自2011年12月至2013年3月在我院眼科确诊的68例（84只眼）糖尿病性视网膜病变黄斑水肿患者,行玻璃体腔内注射TA（40 mg/l）0.1 ml,随访3-15个月,平均8.9个月,观察BCVA、眼压、晶状体、炎症反应,OCT检测黄斑中心凹视网膜厚度,FFA检查观察黄斑部毛细血管渗漏情况。结果 68例（84只眼）患者治疗后视力均有不同程度提高,黄斑水肿减轻。治疗后1、2、3个月平均视力分别为0.39±0.17、0.47±0.20、0.37±0.18,与治疗前平均视力0.19±0.13比较,差异有统计学意义（t值分别为4.482、5.733、4.051,P﹤0.05）。黄斑中心凹视网膜平均厚度分别为（198.12±28.94）μm、（183.66±24.66）μm、（225.96±50.90）μm,与治疗前平均视力（596.35±127.37）μm比较,差异有统计学意义（t值分别为15.253、15.934、13.227,P﹤0.05）。FFA检查显示治疗后荧光渗漏明显减少。9例（9只眼）眼压≥21 mm Hg,其中1例（1只眼）为34.2 mm Hg。5例（7只眼）4-7个月后黄斑水肿复发。2例（2只眼）8个月、12个月后晶状体后囊混浊明显。无感染发生。结论玻璃体腔内注射TA能有效改善糖尿病性黄斑水肿,提高视力,但部分患眼出现黄斑水肿复发、眼压升高,部分出现晶状体混浊加重。

Intravitreous injection of triamcinolone acetonide for diabetic macular edema

Objective To evaluate the efficacy and safety of triamcinolone acetonide（TA） intravitreous injection for the treatment of macular edema due to diabetic retinopathy. Methods A total of 68 patients（84 eyes） diagnosed with macular edema due to diabetic retinopathy were enrolled in this study between December 2011 and March 2013. Patients received intravitreous injection of TA（40 mg /l） 0. 1 mL and were followed-up for 3 to 15 months,with the average followup period being 8. 9 months. Best-corrected visual acuity,intraocular pressure,lens and fundus were closely observed.Retinal thickness was examined with OCT,and vascular leakage was detected with FFA. Results Macular edema reduced and visual acuity improved in 68 patients（84 eyes）. Mean vision acuity was 0. 39 ± 0. 17,0. 47 ± 0. 20 and 0. 37 ± 0. 18 at 1,2,and 3 months,respectively,after the treatment. Comparing with the pre-treatment visual acuity（0. 19 ± 0. 13）,the improvement was statistically significant（ t = 4. 48,5. 73,and 4. 05; P 〈0. 05）. Baseline macular thickness was596. 35 ± 127. 37 μm before the treatment,and it reduced to 198. 12 ± 28. 94 μm,183. 66 ± 24. 66 μm,and 225. 96 ±50. 90 μm after the treatment（ t = 15. 3,15. 9,13. 23,P 〈0. 05）. FFA showed minimal fluorescein leakage. Nine patients（9 eyes） had the IOP ≥21 mm Hg,with the highest being 34. 2 m mHg in one eye. Recurrence of macular edema was found in 7 eyes（5 patients） at 4 to 7 months. At 8 and 12 months,posterior subcapsular cataract was found in 2 eyes（2 patients）. There was no infection. Conclusion Intravitreous injection with TA may be effective in reducing macular edema and improving visual acuity,but recurrence of macular edema,increased intraocular pressure,or posterior subcapsular cataract could occur to some patients.