玻璃体腔内注射曲安奈德(IVTA)治疗非缺血性视网膜中央静脉阻塞引起的黄斑水肿  

Treatment of Macular Edema caused by Non-ischemia Retina Central Venous Occlusion with IVTA

作　　者：郭玉坤 彭小宁[2] 徐尧南[3] 

机构地区：[1]大连市大石桥中心医院眼科,辽宁大连116100 [2]大连医科大学,眼科学研究生辽宁大连116100 [3]大连医科大学附属一院眼科,辽宁大连116100

出　　处：《黑龙江医学》2008年第6期403-406,共4页Heilongjiang Medical Journal

摘　　要：目的通过随机对照的方法来评价玻璃体内注射曲安奈德(TA)治疗非缺血性视网膜中央静脉阻塞(N-CRVO)所致黄斑水肿(ME)的有效性和安全性。方法30例N-CRVO病史的ME患者被随机分为两组,实验组15例接受玻璃体腔内注射4.0 mg TA治疗;对照组15例接受一般活血化瘀药物治疗。玻璃体腔内注射遵循内眼手术规范,于列下角膜缘后3.25 mm(有晶体眼)或3.0 mm(人工晶体眼)处垂直进入玻璃体腔,直视下见针尖后向玻璃体腔内缓慢推注TA,术后保持头正位3 h。保持侧卧位或高枕卧位1周,以防药物沉积于黄斑区影响视力检查。术后乳酸左氧氟沙星滴眼,3次/d,连用3 d。为了尽量减少TA制剂中防腐剂和悬浮剂潜在的视网膜毒性作用,本次实验在注射前,均将TA混悬液静置,去除上清液。两组治疗前后均进行最佳矫正视力、裂隙灯、眼底、眼压、FFA及OCT检查。随访期6个月。结果实验组术后1周、1个月、3个月6、个月的视力分别为(0.2193±0.1098),(0.3067±0.1374)(、0.2852±0.1363)(、0.2500±0.1244),与治疗前(0.0933±0.0898)相比均具有统计学差异(t值分别为-6.298,-8.255,-7.473,-6.078,P值均=0.000)。术后1个月、3个月、6个月视网膜厚度分别为(187.2667±13.9615μm)(195.6667±49.2800)(247.2000±152.5536),与治疗前(589.2667±65.5215)相比均具有统计学差异(t值分别为23.202、20.760、8.329,P值均=0.000)。实验组在术后1个月3、个月、6个月平均眼压均较术前提高,差异有显著性(t值分别为-4.412、-3.461、-2.6351,P值均<0.05)。对照组在治疗后1周、1个月、3个月、6个月视力、视网膜厚度、眼压与治疗前相比均无统计学意义。实验组在术后6个月时,13例(86.6%)黄斑水肿完全消退,2例(13.4%)黄斑水肿复发,复发患者均未选择再注射。对照组在治疗后6个月时,仅2例黄斑水肿自发缓解,13例持续黄斑水肿。实验组5例发生眼压升高,4例局部用药可控制,1例因皮质激素性Objective To discuss the safety and effect of treatment of macular edema caused by non - ischemia retina central venous occlusion （N - CRVO） with IVTA randomly.Methods 30 cases of such patient were divided into two groups randomly. The test group was treated with IVTA 4.0 mg and the control group was treated routinely with removing blood stasis. The IVTA was performed regularly. The eye detections were performed such as eye pressure, vision, FFA and OCT. Results The vision in test group after 1 week, 1, 3, 6 months was （0.2193 ± 0.10983）, （0.3067 ± 0. 1374）, （0.2852 ± 0. 13632）, （0.2500 ± 0. 1244） compared with those before treatment with significant P = 0.000. The retina thickness was decreased compared with those before treatment in test group. The eye pressure was improved after therapy compared with （ P 〈 0.05）. The vision, retina thickness and eye pressure had no difference in control group before and after therapy. The ME was disappeared in 13 cases in test group and 2 cases had further treated with good effect. There 5 cases in test group who had high eye pressure that had treated local drug use and resection of trabeculum without any complications. There were 2 cases in control group who had ischemia and FFA showed no perfusion to receive laser coagulation. Conclusion This method might decrease ME and improve vision but there might be partial relapse.

关 键 词：视网膜静脉阻塞/药物疗法 黄斑水肿 囊样/药物治疗 曲安奈德/治疗应用 

分 类 号：R774[医药卫生—眼科]