曲安奈德玻璃体腔注射联合格栅样光凝治疗囊样黄斑水肿

doi:10.6040/j.issn.1673-3770.0.2014.258

摘要/Abstract

摘要： 目的探讨曲安奈德玻璃体腔注射联合格栅样光凝治疗囊样黄斑水肿的有效性。方法本研究采用前瞻性非随机临床试验比较,对确诊为囊样黄斑水肿的患者14例14眼,经玻璃体腔注射曲安奈德2 mg并行格栅样光凝治疗。对照组为资料齐全并随访时间>6个月的既往病例16例(16眼)。治疗后3、6个月观察最佳矫正视力、眼压、黄斑中心凹视网膜厚度。结果与治疗前视力相比,两组在治疗后3、6个月视力均有提高,差异均有统计学意义(F_对照组=11.4,F_试验组=16.3, P<0.01),试验组治疗前及治疗后3、6个月与对照组相应时间视力比较差异均无统计学意义(t_治疗前=0.122,t_治疗3月=1.11,t_治疗6月=0.79,P≥0.05)。与治疗前黄斑中心凹视网膜厚度相比,两组黄斑中心凹视网膜厚度均有所下降(F_对照组=5.77,F_试验组=7.29,P<0.01),试验组治疗前CMT与对照组相应时间CMT比较差异无统计学意义(t_治疗前=0.288,P>0.05),试验组治疗后3、6个月CMT与对照组相应时间CMT比较差异有统计学意义(t_治疗3月=1.702,t_治疗6月=1.92,P<0.05)。试验组术后4眼(28%)眼压升高。结论曲安奈德玻璃体腔注射联合格栅样光凝治疗能有效降低黄斑中心凹视网膜厚度,但必须警惕高眼压及青光眼的发生。

关键词: 格栅样光凝, 囊样黄斑水肿, 视力, 曲安奈德

Abstract: Objective To determine if primary intravitreal injection of triamcinolone acetonide (TA) in combination with grid laser photocoagulation (GLP) is effective in treating cystoid macular edema. Methods A prospective comparative non- randomized clinical trial was carried out. Fourteen eyes (14 patients) diagnosed with cystoid macular edema were treated with GLP and an intravitreal injection of 2mg TA. A matched control group (16 eyes,16 patients) treated with GLP was selected retrospectively from our medical records. Best-corrected visual acuity (BCVA), intraocular pressure and quantitative changes in optical coherence tomography (OCT) macular thickness were assessed. Results Compared with the pre-treatment, BCVA was significantly elevated in the two groups on 3 and 6 months post-treatment(P<0.01). No obvious improvement of visual acuity was found between the two groups after treatment at any time point (P≥0.05).Macular thickness was significantly decreased after the treatment in the two groups(P<0.01). No significant changes in macular thickness were found between the two groups before the treatment (P>0.05), but macular thickness was lower in the trial group compared with the control group at various time point(P<0.05). IOP raised in 4 eyes(28%) in the trial group. Conclusion Treatment with IVTA injections in combination with grid laser photocoagulation seems to be more effective in decreasing central subfoveal thickness in patients with cystoid macular edema. However, higher intraocular pressure and development of glaucoma must be considered seriously in patients who receive IVTA injection.

Key words: Triamcinolone acetonide, Cystoid macular edema, Visual acuity, Grid laser photocoagulation

中图分类号:

R774.5

严晓腾, 冯军, 康欣乐. 曲安奈德玻璃体腔注射联合格栅样光凝治疗囊样黄斑水肿[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 60-63.

YAN Xiao-teng, FENG Jun, KANG Xin-le. Intravitreal triamcinolone acetonide combined with grid laser photocoagulation for patients with cystoid macular edema[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(1): 60-63.

参考文献

[1] Kang S W, Park C Y, Ham D I. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema[J]. Am J Ophthalmol,2004,137(2):313-322.
[2] 黎晓新,陈玮志. 眼科光学相干断层成像应用新解[M].北京:人民卫生出版社,2011:59-60.
[3] Tso M O. Pathology and pathogenesis of cystoid macular edema[J].Ophthalmologica, 1981, 183(1):46-54.
[4] The Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion[J]. Am J Ophthalmol, 1984, 98(3):271-282.
[5] Early Treatment Diabetic Retinopathy Study Group. Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: early treatment diabetic retinopathy study report No.3. The early treatment diabetic retinopathy study research group[J]. Int Ophthalmol Clin, 1987, 27(4):254-264.
[6] Lee C M, Olk R J. Modified grid laser photocoagulation for diffuse diabetic macular edema. Long-term visual results[J]. Ophthalmology, 1991, 98(10):1594-1602.
[7] Noma H, Funatsu H, Mimura T, et al. Functional-morphological changes after intravitreal injection of Triamcinolone acetonide for macular edema with branch retinal vein occlusion[J]. J Ocul Pharmacol Ther, 2012, 28(3):231-2366.
[8] Gokce G, Sobaci G, Durukan A H, et al.Intravitreal Triamcinolone acetonide compared with bevacizumab for the treatment of patients with macular edema secondary to central retinal vein occlusion[J]. Postgrad Med, 2013, 125(5):51-58.
[9] Noma H, Funatsu H, Mimura T, et al. Macular sensitivity and morphology after intravitreal injection of Triamcinolone acetonide for macular edema with branch retinal vein occlusion[J]. Retina, 2012, 32(9):1844-1852.
[10] Jonas J B, Kreissig I, Sofker A, et al. Intravitreal injection of triamcinolone for diffuse diabetic macular edema[J]. Arch Ophthalmol, 2003, 121(1):57-61.
[11] Loewenstein A, Goldstein M. Intravitreal triamcinolone acetonide for diabetic macula edema[J]. Isr Med Assoc J, 2006, 8(6):426-427.
[12] Binz N, Graham C E, Simpson K, et al. Long-term effect of therapeutic laser photocoagulation on gene expression in the eye[J]. FASEB J, 2006, 20(2):383-385.
[13] Koutsandrea C, Moschos M M, Brouzas D, et al. Intraocular triamcinolone acetonide for pseudophakic cystoid macular edema: optical coherence tomography and multifocal electroretinography study[J]. Retina, 2007, 27(2):159-164.
[14] Arevalo J F, Fernandez C F, Mendoza A J, et al. Intravitreal Triamcinolone combined with grid laser photocoagulation for patients with cystoid macular edema and advanced diabetic retinopathy: pilot study[J]. Arch Soc Esp Oftalmol, 2013, 88(10) :373-379.
[15] Avitabile T, Longo A, Reibaldi A, et al. Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema[J]. Am J Ophthalmol, 2005, 140(4):695-702.
[16] Androudi S, Letko E, Meniconi M, et al. Safety and efficacy of intravitreal triamcinolone acetonide for uveitic macular edema[J]. Ocul Immunol Inflamm, 2005, 13(2-3):205-212.

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