后Tenon囊下注射曲安奈德辅助全视网膜光凝治疗糖尿病视网膜病变  

Posterior sub-Tenon injection of triamcinolone acetonide as adjuvant therapy of panretinal photocoagulation in diabetic retinopathy

作　　者：鲁丹[1] 王康[1] 王艳玲[1] 林鹏耀[1] 李茜[1] 李明铭[1] 

机构地区：[1]首都医科大学附属北京友谊医院眼科,北京市100050

出　　处：《眼科新进展》2013年第5期439-442,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金(编号:81141008;81173412);北京市自然科学基金(编号:7122046);北京市科技计划项目-首都市民健康项目培育(编号:Z11110706730000)~~

摘　　要：目的评价全视网膜光凝前行后Tenon囊下注射曲安奈德在治疗糖尿病视网膜病变上的临床疗效及安全性。方法采用随机、双眼平行对照的研究方法。筛选于我院就诊的糖尿病视网膜病变患者,将双眼患有增生型糖尿病视网膜病变或严重非增生型糖尿病视网膜病变的24例(48眼)患者分为两组,对照组仅行全视网膜光凝,试验组在行全视网膜光凝前1周先行后Tenon囊下注射曲安奈德20mg。6个月后观察最佳矫正视力(logMAR)、视网膜厚度以及眼压的变化。结果治疗后6个月与治疗前视力相比较,对照组最佳矫正视力有所降低,而试验组有所提高,两组治疗后6个月最佳矫正视力相比差异有统计学意义(P=0.04)。治疗后6个月与治疗前视网膜厚度相比较,对照组黄斑中心凹厚度增加了32.8μm,试验组降低了9.7μm,两组相比差异有统计学意义(P=0.03);对照组旁中心凹厚度增加了23.2μm,试验组降低了5.1μm,两组相比差异有统计学意义(P=0.04);对照组中心凹周边厚度增加了18.3μm,试验组增加了0.5μm,两组相比差异无统计学意义(P=0.06)。随访期内,试验组和对照组眼压波动均在正常范围之内。结论全视网膜光凝前行后Tenon囊下注射20mg曲安奈德能有效降低糖尿病性黄斑水肿,是预防由视网膜激光引起的视力下降安全有效的方法。Objective To investigate the efficacy and safety of posterior subTenon capsule injection of triamcinolone acetonide （PSTA） on diabetic retinopathy before panretinal photocoagulation（PRP）. Methods A random two-eye parallel control design was taken. 24 patients （48eyes） with severe non-proliferative bilateral diabetic retinopathy or proliferative bilateral diabetic retinopathy were divided into a control group and an experimental group. The control group received panretinal photocoagula- tion only,and the experimental group received a single PSTA（20 mg） before panretinal photocoagulation. The best-corrected visual acuity（BCVA） was tested using the logarithm of the minimum angle of resolution （logMAR） ; retinal thickness and the change of intraocular pressure （IOP） were also tested 5 months after the operation. Results Compared with preoperative BCVA, BCVA of the control group was lower and that of the experimental group was higher 6 months after the operation. Difference of postoperative BCVA between the two groups was of statistical significance （P = 0.04 ）. Central foveal thickness of the control group increased by 32.8 μm and that of the experimental group decreased by 9.7 μm （P = 0.03 ） ; Paracentral foveal thickness of the control group increased by 23.2 μm and that of the experimental group decreased by 5. 1 μm （P = 0. 04） ; Perifoveal thickness of the control group increased by 18.3 μm and that of the experimental group increased by 0.5 μm（P = 0.05）. The IOP change of the two groups were both within normal range. Conclusion Performing PSTA（20 mg） before PRP is a safe and effective way of alleviating macnlar edema and preventing diminution of vision induced by PRP.

关 键 词：后Tenon囊 曲安奈德 糖尿病视网膜病变 黄斑水肿 全视网膜光凝 

分 类 号：R774.1[医药卫生—眼科]