曲安奈德两种给药方式治疗糖尿病性黄斑水肿的疗效对比观察  

The effect of triamcinolone acetonide by single intravitreous injection or repeatedly sub-Tenoninfusion on relieving diabetic macular oedema

作　　者：刘红玲[1] 冯广忠[1] 刘建巨[1] 崔浩[1] 傅少颖[1] 

机构地区：[1]哈尔滨医科大学附属第一医院眼科,150001

出　　处：《眼科》2009年第4期246-250,共5页Ophthalmology in China

基　　金：黑龙江省卫生厅课题资助(2005-146)

摘　　要：目的观察曲安奈德注射液玻璃体腔注射(IVI)和Tenon囊下给药(STi)治疗糖尿病性黄斑水肿的疗效。设计回顾性病例系列。研究对象37例通过荧光素眼底血管造影(FFA)和相干光断层扫描(OCT)诊断的糖尿病性黄斑水肿患者。方法分别给予一次性曲安奈德(4mg)玻璃体腔注射(n=19)或三次(0d、2w、4w)Tenon囊下给药(40mg/次)(n=18)。治疗后4、8、12、16、20、24w复查最佳矫正视力、眼底、眼压、FFA、OCT,评价其疗效。主要指标视力、视网膜黄斑中心凹厚度、眼压。结果32例患者完成了24周的观察研究。IVI组治疗前及治疗后24周的视力分别为(0.10±0.03)、(0.24±0.06)(F=15.459,P=0.000);黄斑中心凹视网膜厚度分别为(460.73±46.33)μm、(394.53±41.43)μm(F=25.282,P=0.0000)。STi组治疗前及治疗后24周的视力分别为(0.11±0.04)、(0.18±0.07)(F=6.989,P=0.000);黄斑中心凹视网膜厚度分别为(454.76±56.28)μm、(424.94±42.69)μm(F=5.145,P=0.000)。同一时间点,IVI的治疗效果较STi更显著,差异具有统计学意义(P均<0.05)。两组患者未出现严重、不可逆转并发症。结论曲安奈德玻璃体腔注射和Tenon囊下多次给药均是治疗糖尿病性黄斑水肿的有效方法;玻璃体腔注射效果更显著,Tenon囊下给药更安全。Objective To study the efficacy of intravitreous injection （IVI） or sub-Tenoninfusion （STi） of triamcinolone acetonide （TA） for diabetic macular oedema. Design Retrospective cases series. Participants 37 cases （37 eyes） with diabetic macular oedema confirmed by fundus fluorescence angiography （FFA） and optical coherence tomography （OCT）. Methods Patients were received 4mg TA by single intravitreous injection or 40mg TA by three times sub-Tenoninfusion at 0d, 2w, 4w. The best corrected visual acuity, fundus examination, intraocular pressure, fundus fluorescence angiography were further analyzed, and the retinal thickness of macular fovea were measured by OCT. Main Outcome Measures The visual acuity, thickness of retinal macular fovea, ocular pressure was measured. Results 32 cases （32 eyes） completed the 24 week followed-up. In group IVI, the visual acuity before and after injection was 0.10±0. 03, 0.24±0.06（F=15.459, P=0.000） respectively; and retinal thickness of macular fovea is（460.73±46.33）μm,（394.53±41.43）μm （F=25. 282, P=0.0000） respectively. But in group STi, the visual acuity before and after injection is 0.11±0.04, 0.18±0.07（F=6.989, P=0.000） accordingly; and retinal thickness of macular fovea is （454.76±56.28） μm,（424.94±42.69 ）μm （F=5.145, P=0.000） respectively. There was obvious statistical significance between two methods at same time point（all P〈0.05 ）. The serious, irreversible complications had not been found in all patients during follow-up. Conclusion Triamcinolone acetonide by single intravitreous injection or repeatedly sub-Tenoninfusion are good ways to relieve diabetic macular oedema. IVA-TA is more effective, and STi-TA safer. （Ophthalmol CHN, 2009, 18： 246-250）

关 键 词：曲安奈德 玻璃体腔注射 Tenon囊下给药 糖尿病性黄斑水肿 

分 类 号：R774.5[医药卫生—眼科] R587.1[医药卫生—临床医学]