两种方法注射曲安奈德治疗糖尿病黄斑水肿的临床疗效观察  

Intravitreal versus retrobulbar injection of triamcinolone acetonide for diabetic macular edema

作　　者：郑建秋[1] 苏金良[2] 滕岩[1] 董丽[1] 张蕾[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院眼科医院,黑龙江哈尔滨150001 [2]哈尔滨医科大学第五临床医学院眼科,黑龙江大庆163316

出　　处：《哈尔滨医科大学学报》2010年第3期250-255,共6页Journal of Harbin Medical University

基　　金：黑龙江省教育厅科学技术研究项目(11511217)

摘　　要：目的评价玻璃体内注射曲安奈德(IVTA)和球后注射曲安奈德(RBTA)两种方法辅助光凝治疗糖尿病黄斑水肿(DME)的临床疗效和安全性。方法 DME患者17例,双眼光凝后随机选取1只眼玻璃体内注射曲安奈德0.1 mL(4 mg),该组17只眼为IVTA组,另外17只眼为其对照组;DME患者23例,双眼光凝后随机选取1只眼球后注射曲安奈德1 mL(40 mg),该组23只眼为RBTA组,另外23只眼为其对照组。两注药组和各自对照组治疗前及治疗后1、3、6个月均进行最佳矫正视力、眼压、光相干断层扫描(OCT)及眼前后节检查,所得数据进行配对检验或两个独立样本检验。结果 IVTA组注药前视力为0.19±0.11,注药后1、3个月视力分别为0.33±0.12、0.39±0.11,与注药前相比有统计学意义(P<0.05),6个月的视力为0.23±0.08,与注药前相比无统计学意义(P>0.05);RBTA组注药前视力为0.21±0.11,注药后1、3及6个月视力分别为0.30±0.12、0.37±0.11、0.29±0.08,与注药前相比均有统计学意义(P<0.05);RBTA组6个月时视力高于IVTA组,有统计学意义(P<0.05)。IVTA组注药前OCT值为(653.18±111.89)μm,注药后1、3及6个月OCT值分别为(372.71±59.21)μm、(307.77±70.18)μm、(573.06±127.43)μm,与注药前相比均有统计学意义(P<0.05);RBTA组注药前OCT值为(634.48±124.96)μm,注药后1、3及6个月OCT值分别为(383.57±61.71)μm、(326.30±87.72)μm、(459.87±112.05)μm,与注药前相比均有统计学意义(P<0.05);RBTA组6个月时OCT值低于IVTA组,有统计学意义(P<0.05)。IVTA组注药后1个月眼压为(17.35±4.14)mmHg,与注射前(15.71±2.34)mmHg相比有统计学意义(P<0.05),注药后3、6个月与注射前相比无统计学意义(P>0.05);RBTA组眼压注药后与注药前相比无明显波动。6个月时两组均没有新发白内障发生,未见眼内炎和视网膜脱离发生。结论 IVTA和RBTA辅助光凝治疗DME均有显著效果,RBTA比IVTA操作简便,风险较小,而且效力更加持久。Objective To evaluate the efficacy and safety of intravitreal triamcinolone acetonide injection（IVTA） and retrobulbar triamcinolone acetonide injection（RBTA） for the treatment of diabetic macular edema（DME）.Methods Forty patients with DME were recruited.Before injection all patients were treated by laser photocoagulation,17 patients were recruited for IVTA,in the same patient one eye was assigned to 0.1mL（4mg） IVTA and the fellow was the control eye.23 patients were recruited for RBTA,in the same patient one eye was assigned to 1mL（40mg）RBTA and the fellow was the control eye.Beforeand 1,3 and 6 months after treatment,visual acuity as well as intraocular pressure and thickness of themacula with optical coherence tomography（OCT）were measured.The data were analyzed by Two-SamplePaired t-test for Means or Two-Sample t-test for Means.Results The eyes treated with IVTA displayedsignificant improvement in visual acuity,both after 1 month（0.33±0.12,P0.05）and 3 months（0.39±0.11,P〈0.05）of treatment.Significant improvement was displayed also in eyes with RBTA,after 1month（0.30±0.12,P0.05）,3 months（0.37±0.11,P〈0.05）,and 6 months（0.29±0.08,P〈0.05）.The difference between IVTA（0.23±0.08）and RBTA（0.29±0.08）became significant 6months after treatment（P〈0.05）.Macular thickness of the eyes treated with IVTA were significantly reduced after 1 month（372.71±59.21）μm（P〈0.05）,3 months（307.77±70.18）μm（P〈0.05）and 6months（573.06±127.43）μm（P〈0.05）of treatment compared to（653.18±111.89）μm（P〈0.05）of before treatment.The eyes treated with RBTA were significantly reduced after 1 month（383.53±61.711）μm（P0.05）,3 months（326.30±87.72）μm（P〈0.05）and 6 months（459.87±112.05）μm（P〈0.05）of treatment compared to（634.48±124.96）μm（P〈0.05）of before treatment.Thedifference between IVTA and RBTA became significant 6 months after the treatment（P〈0.05）.Intraocular pressure of the eyes treated wi

关 键 词：黄斑水肿 曲安奈德注射液 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R774.5[医药卫生—内科学]