曲安奈德3种混合剂型在玻璃体视网膜手术中应用的效果比较  

Comparison of the efficacy among three mixed dosage forms of triamcinolone acetonide in vitreoretinal surgery

作　　者：张群英 王帅[1] 李龙[1] 王文战[1] Zhang Qunying;Wang Shuai;Li Long;Wang Wenzhan(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科,河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2022年第4期260-266,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省科技厅科技公关项目(212102310309)。

摘　　要：目的比较曲安奈德(TA)的3种混合剂型在玻璃体视网膜手术中应用的效果。方法前瞻性病例对照研究。纳入郑州大学第一附属医院2020年6月至2021年7月行复杂玻璃体视网膜手术联合硅油填充术者117例(117只眼), 按随机数字表法分为3组:A组, TA与平衡盐溶液1∶1混合, 39例(39只眼);B组, TA与透明质酸钠凝胶1∶1混合, 41例(41只眼);C组, TA与羟丙基甲基纤维素1∶1混合, 37例(37只眼)。3组均在术毕前将药物注射于视网膜病灶处0.1 ml(含TA 2 mg)。结果 A组大部分药物在后极部呈团块状沉积, 而未贴附于病灶处;B组及C组大部分药物在玻璃体腔呈部分弥散状态, 小部分贴附在病灶处, 未沉积在后极部, 3组差异有统计学意义(χ^(2)=95.57, P<0.001);A、B、C 3组术后早期视力提高率依次为23.1%(9/39)、63.4%(26/41)、70.3%(26/37), 差异有统计学意义(H=17.91, P<0.001)。术后3个月视力提高率、高眼压发生率、炎症反应、增生性玻璃体视网膜病变的发生率, 3组差异均无统计学意义(均P>0.05)。结论曲安奈德与透明质酸钠凝胶或与羟丙基甲基纤维素的混合剂型可避免药物沉积在后极部, 使部分药物更加准确的贴附在视网膜病灶处, 早期视力提高较明显。Objective To compare the efficacy among three mixed dosage forms of triamcinolone acetonide(TA)in vitreoretinal surgery.Methods This was a prospective case-control study.A total of 117 eyes of 117 patients who underwent complex vitreoretinal surgery combined with silicone oil tamponade from Jun.2020 to Jul.2021 in the First Affiliated Hospital of Zhengzhou University was included.They were divided into three groups based on random number table methods.Thirty-nine eyes of 39 patients in group A received 1∶1 mixture of TA and balanced salt solution.Forty-one eyes of 41 cases in group B received mixed TA and sodium hyaluronate gel 1∶1.Thirty-seven eyes of 37 cases in group C received mixed TA and hydroxypropyl methylcellulose 1∶1.In the three groups,0.1ml drug(containing TA 2 mg)was injected into the retinal lesions before the end of the operation.Results Most of the drugs in group A were deposited in clumps at the posterior pole,but not attached to the lesion.Most of the drugs in group B and group C were partially diffused in the vitreous cavity,and a small part was attached to the lesion and not deposited in the posterior pole.The difference among the three groups was statistically significant(χ^(2)=95.57,P<0.001).The early postoperative visual acuity improvement rates in group A,group B and group C were 23.1%(9/39),63.4%(26/41)and 70.3%(26/37),and the difference was statistically significant(H=17.91,P<0.001).There were no significant differences in the visual acuity improvement rate,the incidence of high intraocular pressure,inflammatory reaction,and the proliferative vitreoretinopathy at three months after surgery(all P>0.05).Conclusion The mixed dosage forms of triamcinolone acetonide and sodium hyaluronate gel or with hydroxypropyl methylcellulose can avoid drug deposition in the posterior pole,thus part of the drug can attach to the retinal lesions with more accuracy,and the early vision improvement is more obvious.

关 键 词：玻璃体切除术 硅油类 曲安奈德 透明质酸钠 纤维素 甲基 羟丙基 

分 类 号：R779.6[医药卫生—眼科]