曲安奈德辅助23G微创玻璃体切割治疗增生性糖尿病视网膜病变  

23-Gauge Mini-invasive Vitrectomy Combined with Adjunctive Triamcinolone Acetonide for Proliferative Diabetic Retinopathy

作　　者：周林 李芳芳 ZHOU Lin;LI Fang-fang(Department of Ophthalmology,The Second People＇s Hospital of Huai＇an,Huai＇an Affiliated Hospital of Xuzhou Medical University,Huai＇an 223002,Jiangsu,China)

机构地区：[1]江苏省淮安市第二人民医院徐州医科大学附属淮安医院眼科,淮安223002

出　　处：《中国现代手术学杂志》2018年第4期306-310,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨23G微创玻璃体切割联合球内及后Tenon囊下应用曲安奈德治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的安全性和有效性。方法选择行23G玻璃体切割手术治疗的PDR患者86例(95只眼)进行回顾性研究。按治疗方式分为两组:联合药物治疗组40例(48眼),行标准三切口玻璃体切割术,术中球内注入曲安奈德8 mg行玻璃体染色并切割吸出,术毕后Tenon囊下注射曲安奈德30 mg;单纯手术治疗组46例(47眼),单纯行玻璃体切割手术,未注射曲安奈德。比较两组术后矫正视力及眼压情况,黄斑中心凹厚度(central macular thickness,CMT)变化及前房炎症反应情况。结果所有患者随访6个月～2年,平均(1. 31±0. 63)年。组内比较,两组治疗后各时间点最佳矫正视力(BCVA)、CMT值均较术前改善(P均<0. 05);组间比较,术后1月、3月、6月联合药物治疗组BCVA、CMT均优于单纯手术治疗组,差异均有统计学意义(P均<0. 05)。两组患者眼压稳定,各时间点组内和组间比较均无统计学差异(P均> 0. 05)。术后联合药物治疗组前房炎症反应较单纯手术治疗组轻,差异具有统计学意义(P <0. 05)。手术后3～5 d,前房反应逐渐消失,所有病例未发生术后感染。结论 23G微创玻璃体切割联合曲安奈德术中玻璃体染色及术毕后Tenon囊下注射治疗增生性糖尿病视网膜病变有效安全,能减轻黄斑水肿,改善视功能。Objective To study the safety and efficacy of 23-gauge mini-invasive vitrectomy combined with posterior sub-Tenoncapsule injection of triamcinolone acetonide in treating proliferative diabetic retinopathy （PDR）. Methods A total of 86 PDR patients with 95 eyes underwent 23G vitrectomy were analyzed retrospectively. According to therapeutic method, they were divided into two groups： 40 cases of 48 eyes were treated by pars plana vitrectomy combined with injection of triamcinolone acetonide （TA） as the combined group, and 8 mg of TA was injected into the eyes for dying of vitreous during the operations and 30 mg of TA was injected in the posterior sub-Tenoncapsule. 46 cases of 47 eyes were performed direct vitrectomy as pure surgery group. The best corrected visual acuity（BCVA）, intraocular pressure （IOP）, changes of central macular thickness（CMT）, and inflammation reaction of anterior chamber were compared between the two groups. Results All cases were followed up for 6 months to 2 years with an average of 1.31±0.63 years. The BCVA and CMT of the both groups were improved after treatment than those before the operation （ P 〈0.05）. Both BCVA and CMT were better in the combined group than those in the pure surgery group at 1-, 3- and 6 months after the operation, and the differences were statistical （ P 〈0.05）.The IOP was stable in both groups, and there was no statistic difference at different time points in both groups and between the two groups （ P 〉0.05）. The inflammation reaction of anterior chamber in combined group was less than that in the pure surgery group （ P 〈0.05）.Conclusion 23-gauge mini-invasive vitrectomy combined with posterior sub-Tenoncapsule injection of TA can reduce macular edema and improve visual acuity, and it is safe and effective for PDR.

关 键 词：玻璃体切割术 增生性糖尿病视网膜病变 曲安奈德 玻璃体染色 后TENON囊下注射 

分 类 号：R774.1[医药卫生—眼科]