球周注射曲安奈德联合全视网膜光凝治疗糖尿病黄斑水肿疗效观察  

Retrobulbar injection of triamcinolone acetonide combined with retinal photocoagulation in treatment of diabetic macular edema curative effect observation

作　　者：张大卫[1] 张蕊[1] 杨敏[1] 孔凡宏[1] 

机构地区：[1]首都医科大学附属北京潞河医院眼科,101149

出　　处：《疑难病杂志》2016年第12期1263-1267,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的评估球周注射曲安奈德（TA）联合全视网膜光凝（PRP）治疗糖尿病视网膜病变合并黄斑水肿的安全性和有效性。方法选择2013年12月—2015年6月首都医科大学附属北京潞河医院46例（46只眼）严重的非增殖期糖尿病视网膜病变患者,分为试验组（球周注射TA联合PRP）和对照组（只接受PRP治疗）,每组23例23只眼。在治疗前以及治疗后1、3、6个月不同时间点记录最佳矫正视力（BCVA）、眼压（IOP）及黄斑区中心凹厚度（CMT）的变化,并行眼底荧光血管造影（FFA）检测。结果试验组BCVA治疗后1月、3月优于治疗前,差异有统计学意义（P〈0.05）,CMT较治疗前明显减轻,差异有统计学意义（P〈0.05）;对照组BCVA治疗后1月、3月差于治疗前,差异有统计学意义（P〈0.05）,CMT与治疗前比较亦增加。试验组和对照组治疗后1月、3月BCVA比较差异有统计学意义（P〈0.05）,试验组视力明显好于对照组;试验组治疗后1月CMT明显低于对照组,差异有统计学意义（P〈0.05）。治疗前后眼压波动在正常范围,试验组治疗1个月眼压和对照组治疗6个月眼压均较治疗前升高,差异有统计学意义（P〈0.05）。试验组治疗后1月眼压高于对照组,差异有统计学意义（P〈0.05）。治疗后2~3月行眼底荧光血管造影（FFA）复查仅试验组1例患者（局部黄斑水肿）显示视网膜周边及黄斑区扩张的毛细血管荧光素渗漏完全消失。2组均未出现并发症。结论球周注射TA联合PRP治疗糖尿病视网膜病变较单纯PRP治疗有效,可以在短时间内提高视力,减轻黄斑水肿。2~3个月复查.FFA,再给予补充激光光凝治疗。Objective To investigate the efficacy and safety of peribulbar injection of triamcinolone acetonide（peribulbar TA） on diabetic retinopathy with macular edema before laser photocoagulation.Methods Forty six eyes with severe non proliferative unilateral diabetic retinopathy were divided into an experimental group（received a single peribulbar TA before laser photocoagulation,TA group） and a control group（received laser photocoagulation only）.The best corrected visual acuity（BCVA）,the change of intraocular pressure（IOP） and central macular thickness（CMT） were measured before and after treatment in 6 months.Results The follow up period were six months.BCVA in TA group at the 1 month and 3 month was better than that before treatment,the change had significant difference（P〈0.05）,and correspondingly CMT reduced significantly（P〈0.05）;BCVA in control group at the 1 month and 3 month was worse than that before treatment and the change had significant difference（P〈0.05）,and CMT increased correspondingly more than that before treatment;At the 1month and the 3 month follow up,the changes of the BCVA between two groups had significant differences（P〈0.05）,and the visual acuity in TA group was much better than that in control group;CMT in TA group at the 1 month reduced more significantly than that in control group,and the change had significant difference（P〈0.05）.The changes of IOP in TA group or in control group were normal before and after treatment,but IOP in TA group at die 1 month was higher than that in control group（P〈0.05）.Only one patient in TA group（focal macular edema） show that fluorescein leakage of peripheral retina and macular dilated capillary disappeared completely when re-examination of fluorescein fundus angiography（FFA） after treatment in 2 or 3 month.Conclusion The combination of TA and PRP in the treatment of diabetic retinopadiy is more effective than the simple PRP treatment.It can improve visual acuity and reduce macular edema in a short

关 键 词：球周注射 曲安奈德 视网膜光凝 糖尿病视网膜病变 黄斑水肿 

分 类 号：R587.2[医药卫生—内分泌] R779.63[医药卫生—内科学]