球后注射曲安奈德联合全视网膜光凝治疗糖尿病性黄斑水肿的疗效及安全性评价

摘要

Objective To discuss the efficacy and safety of triamcinolone acetonide (TA)retrobulbar injection combined with panretinal photocoagulation (PRP)in the treatment of diabetic macular edema (DME), and to explain the advantages of this combination treatment method in treating DME.Methods Sixty-four cases (64 eyes) with macular edema due to diabetic retinopathy(DR)were randomly divided into combination treatment group(n=34,treated with TA retrobulbar injection combined with PRP)and PRP group(n=30,received PRP treatment only).The changes in the best corrected visual acuity (BCVA), the fovea centralis thickness (CMT), and the intraocular pressure(IOP)before treatment and in 1 month, 3 months, 6 months after treatment were compared. Results The BCVA was improved in both groups after treatment. However, the BCVA improvement in combination treatment group was statistically more significant (P<0.05)compared with PRP group in 1 month, 3 months and 6 months after treatment. The resolution of DME after treatment as compared with that before treatment,the CMT reduced in two groups in 1 month,3 months,6 months after treatment.At each stage,the CMT in combination treatment group was lower than PRP group (P<0.05 ). No complications of glaucoma, cataract,vitreous hemorrhage,retinal detachment,choroidal detachment,and endophthalmitis were found in all patients.Conclusion For the patients with DME,the combination treatment with TA retrobulbar injection and PRP has a better therapeutic effect than the sole PRP treatment in reducing the macular edema and improving the BCVA.The operation is simple and has less complication.%目的：探讨球后注射曲安奈德（TA）联合全视网膜光凝（PRP）治疗糖尿病性黄斑水肿（DME）的临床疗效与安全性，阐明这种联合治疗方法治疗 DME的优势。方法：将糖尿病性视网膜病变（DR）伴黄斑水肿患者64例（64眼）随机分为联合治疗组（34眼行球后注射TA联合PRP治疗）和单纯光凝组（30眼仅行 PRP治疗）。比较治疗前及治疗后1个月、3个月和6个月2组患者最佳矫正视力（BCVA）、黄斑光学相干断层扫描（OCT）检测黄斑中心凹处视网膜厚度（CMT）及眼压（IOP）的变化。结果：经过治疗，2组患者BCVA均获得提高，联合治疗组较单纯光凝组患者视力提高更多（P＜0.05）。与治疗前比较，治疗后1个月、3个月和6个月时2组患者CMT均降低（P＜0.05）。治疗后各阶段联合治疗组CMT均值小于单纯光凝组（P＜0.05）。治疗过程中2组患者均未发生青光眼、白内障、玻璃体积血、视网膜脱离、脉络膜脱离和感染性眼内炎等眼部严重并发症。结论：PRP治疗DR并发黄斑水肿时联合球后注射TA可以促进水肿吸收并改善患者视力，且操作简单，并发症少。