曲安奈德辅助玻璃体切除术的临床观察  

The clinical observation on Triamcinolone-assisted vitrectomy

作　　者：齐黔方[1] 马翔[2] 

机构地区：[1]大连医科大学附属市中心医院眼科,辽宁116083 [2]大连医科大学附属一院眼科

出　　处：《中华眼外伤职业眼病杂志》2014年第12期903-908,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的探讨曲安奈德（TA）玻璃体内注射辅助玻璃体切除术对降低手术操作难度及提高手术效果的意义。方法不同原因导致的玻璃体视网膜疾病需行玻璃体切除术治疗的41例（44眼），分为TA组和对照组。TA组18例（21眼）常规行玻璃体切除术，中央玻璃体切除后，注入曲安奈德混悬液，标识网膜前残存的玻璃体。对照组23例（23眼）单纯玻璃体切除组仅在无菌条件下常规行闭合式玻璃体切除术。比较TA组和对照组手术中操作难度的作用、手术效果，术后1d、3d、1周、1月、2月、3月最佳矫正视力、眼压、眼内炎症反应及晶状体状况。结果TA组术中注入曲安奈德辅助玻璃体染色，可明显改善玻璃体后皮质、视网膜前膜及视网膜内界膜的辨识度，降低手术难度，缩短手术时间，提高手术的安全性。两组间术后最佳矫正视力的差异无统计学意义；TA组术后炎症反应较对照组明显减轻，差异有统计学意义；TA组术后出现眼压升高及白内障的发生发展与对照组相比并无明显差异。结论相对于单纯行玻璃体切除术，玻璃体内注射曲安奈德辅助玻璃体切除术可以降低手术难度，缩短手术时间并提高手术的安全性，玻璃体切除术术后TA组与对照组相比短期内的最佳矫正视力未见明显差异，但可明显减轻眼内炎症反应，减轻黄斑区水肿，术后恢复较快，并发症较少。Objective To investigate the effect of Triamcinolone acetonide （TA） assisted vitrectomy on reducing difficulty of operation and improving operation effect. Methods Forty-four eyes of 41 patients who underwent vitrectomy for vitreoretinal diseases were divided into TA treatment group and control group. Intravitreal injection of TA combined vitrectomy was performed in 21 eyes of 18 cases in TA treatment group before peeling the posterior vitreous cortex. The control group, 23 eyes of 23 eases, were treated by the simple closed vitrectomy operation. The operation difficulty and effect, the best corrected visual acuity, intraocular pressure, intraocular inflammation, and lens changes were compared at 1 day, 3 days, 1 week, 1 month, 2 months,3 months after the operation in all patients between the TA treatment group and the control group. Results In TA treatment group , intraoperative injecting TA to assist vitreous staining through scleral incision improved identification of the posterior vitreous cortex, the epiretinal membrane and inner limiting membrane, reduced the operation difficulty, shortened operation time, and improved operation safety. The postoperative best corrected visual acuity of the TA treatment group had no better than the control group, but the inflammatory reaction after operation was obviously better compared with the control group, and the difference had statistical significance. The elevated intraocular pressure and the occurrence of cataract between the TA treatment group and the control group had no significant difference. Conclusion Compared with simple vitrectomy, intravitreal injection of TA combined with vitrectomy can reduce the operation difficulty, shorten the operation time and improve operation safety. The postoperative best corrected visual acuity is not improved with TA treatment, but injection of TA can reduce intraocular inflammation, and complications, and accelerate postoperative recovery.

关 键 词：曲安奈德 玻璃体切除术 临床疗效 并发症 

分 类 号：R779.6[医药卫生—眼科]