玻璃体内注射曲安奈德治疗黄斑水肿后黄斑区形态和功能的研究  

Mlacular morphology and functional changes after intravitreal triamcinolone acetonide for macular edema

作　　者：袁玲[1] 袁援生[1] 钟华[1] 李燕[1] 程玉霞[1] 蔡斌[1] 李艳梅[1] 

机构地区：[1]昆明医学院第一附属医院眼科,昆明650032

出　　处：《中国实用眼科杂志》2006年第1期13-18,共6页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察玻璃体内注射曲安奈德（intravitreal injection of triamcinolone acetonide，IVTA）治疗黄斑水肿后视网膜形态和功能的变化。方法对黄斑水肿的患者35例37只眼经玻璃体内注射曲安奈德后定期随访6月，对比分析治疗前后的最佳矫正视力、光学相干断层扫描、视野检查、眼底荧光造影及眼压的变化情况。统计学方法采用SPSS统计软件进行配伍组设计的两因素方差分析，差异有显著性时用S-NK法行q检验两两比较，相关因素用Pearson相关分析。结果全部患者IVTA后最佳矫正视力均比术前提高（P〈0．05）。OCT测量黄斑区视网膜厚度，IVTA前黄斑区视网膜厚度为（602．53±191．27）μm，IVTA后1、3、6月分别为（271.80±93．77）μm、（207．87±81.88）μm、（273．87±187．17）μm，IVTA前后相比有显著性差异（P〈0．05）。复发患者再次IVTA后CMT仍显著降低。在视野检查中，IVTA后1、3、6月黄斑区中心凹阈值均比术前有明显改善；IVTA后平均缺损绝对值较IVTA前减小；IVTA后模式标准差值较IVTA前减小。IVTA前后最佳矫正视力与黄斑区视网膜厚度为显著负相关（P〈0．05），与黄斑中心凹光敏感度呈高度正相关（P〈0．01）。结论IVTA治疗黄斑水肿随访半年，患者中心视力显著提高，黄斑水肿减轻，荧光造影显示黄斑区荧光渗漏减少甚至部分患者无渗漏。黄斑区视网膜厚度显著降低，视网膜光敏感度有显著提高，视野缺损也有所降低，中心暗点减少。IVTA后3～6月出现黄斑水肿复发，再次行IVTA病情仍可有明显改善。Objective To observe retinal morphology and functional changes after intravitreal Triamclnolone Acetonide for macular edema. Methods 37 eyes of 35 patients undergoing intravitreal Trlamcinolone Acetonide （IVTA） for macular edema were enrolled in this prospective study. Optical coherence tomography （OCT） and perimetry, fundus fluorescein angiography （FFA） were performed before and 1 month, 3 months, 6 months after IVTA. OCT was performed to measure the neuroepithelial layer thickness of macular fovea. At the same time, perimetry was performed by Humphrey Ⅱ- 750 visual field analysis. We used the central 10- 2 fast threshold program to examine the change in central 10 degree. Results of visual field were printed automatically. Statistical analyses were performed by SPSS for Windows using the randomized complete block design ANOVA. Results Best correct visual acuity of all patients after IVTA were better than before. Central macular thickness （CMT）obtained by OCT, Mean CMT before IVTA was （602.53±191.27）μm, while CMT significantly decreased to （271.80±93.77） μm, （207.87±81.88）μm, （273.87±187.17）μm at 1, 3, 6 months after IVTA （P〈0.05）. The fovea threshold was singificantly improved than before IVTA at 1, 3, 6 months after IVTA （P 〈 0.05）. Total sensitivity was significantly improved than before IVTA at 1, 3, 6 months after IVTA （P 〈 0.05） in macular 10 - 2 threshold test. Of the indices of perimetery, Mean Defect has a significant differences among pre-iVTA and post-IVTA and PSD show significant reduction before and after IVTA （P〈 0.05）. The results of fundus fluorescein angiography show that leakages in macular vascular decreased after IVTA at every follow-up. Intraocular pressure elevated transiently in most patients, but IOP could be controlled by local drops. Conehtsions By 6 - month of follow-up, macular edema significant remlved and the best-corrected visual acuity significant improved after IVTA. There is a significant decrease in macular leaka

关 键 词：玻璃体内注射 曲安奈德 黄斑水肿 视野 眼底荧光造影 光学相干断层扫描 

分 类 号：R774.1[医药卫生—眼科] R774.5[医药卫生—临床医学]