DR患者玻璃体切割术后黄斑水肿的治疗

目的:观察增生性糖尿病视网膜病变（proliferative diabetic retinopathy, PDR)玻璃体切割术后球周注射曲安奈德（triamcinolone acetonide, TA)联合黄斑区补充光凝治疗黄斑水肿的临床疗效。方法:PDR患者43例行玻璃体切割术及眼内全视网膜光凝术毕球周注射TA 40mg/mL,术后1wk选择有黄斑水肿患者32例,术后2wk行黄斑区补充532nm激光,术后1wk；1,3,6mo随访最佳矫正视力（best-corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度（central macular thickness, CMT)、并发症。结果:术后1mo视力提高28例（88%),视力不变4例（12%）,与术后1wk比较差异有显著性（P< 0.05）；术后3,6mo检查BCVA变化不大,与术后1mo比较均无显著性差异（P>0.05）；术后1wk CMT明显增厚,术后1mo黄斑水肿均不同程度减轻,与术后1wk比较差异有显著性（P<0.05）,术后3,6mo CMT变化不大,与术后1mo比较均无显著性差异（P> 0.05）。所有患者术后反应较轻,未出现严重并发症。结论:术后球周注射TA与黄斑区补充光凝结合起来治疗PDR患者术后糖尿病黄斑水肿取得了满意持久的临床效果。

Clinical observation of the treatment of macular edema after vitrectomy in patients with proliferative diabetic retinopathy

AIM:To study the efficacy of retrobulbar injection of triamcinolone acetonide(TA) combined with macular laser photocoagulation after vitrectomy in patients with proliferative diabetic retinopathy(PDR) for the treatment of diabetic macular edema.METHODS:PPV combined with full panretinal photocoagulation were performed in 43 cases with PDR, 40mg/mL TA after operation were injected retrobulbarly, 32 cases with macular edema diagnosed 1 week later were treated with macular laser photocoagulation(532nm) 2 weeks postoperatively. The best-corrected visual acuity(BCVA), CMT and complications were analyzed after postoperative 1 week, 1 month, 3 and 6 months.RESULTS:Twenty-eight cases’ BCVA(88%) increased after 1 month, 4 cases(12%) were not changed. The difference of BCVA after 1 month compared with after 1 week was statistically significant(P<0.05), the difference of BCVA after 3 and 6 months compared with after 1 month was not statistically significant(P>0.05). The CMT was thickening after 1 week, and decreased after 1 month compared with after 1 week, the difference was statistically significant(P<0.05). The difference of CMT after 3 and 6 months compared with after 1 month was not statistically significant(P>0.05). The serious, irreversible complications had not been found in all patients during follow-up.CONCLUSION:Retrobulbar injection of TA combined with macular laser photocoagulation for the treatment of PDR, postoperative DEM gained satisfactory and long lasting clinical effect.