摘要:
Objective To observe the short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide (PSTA) in the treatment of macular edema due to ischemic retinal vein occlusions (RVO).Methods A retrospective clinical study.A total of 53 eyes of 53 patients with RVO macular edema diagnosed by fundus color photography,fundus fluorescein angiography and optical coherence tomography (OCT) were included in the study.The best corrected visual acuity (BCVA) was detected by the international standard visual acuity chart,and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity.The central macular thickness (CMT) was measured by OCT.Among 53 eyes,there were 27 eyes with ischemic RVO maeular edema (ischemic group) and 26 eyes with non-ischemic RVO macular edema (non-ischemic group).The mean logMAR BCVA was 0.82±0.37,mean CMT was (662.1±216.7) μm in ischemic group.The mean logMAR BCVA was 0.41±0.23,mean CMT was (548.0± 161.9) μm.The differences of logMAR BCVA and CMT between the two groups werw both statistically significant (t =4.745,2.258;P< 0.05).All eyes were treated with a single sub-Tenon injection of 0.4 ml triamcinolone acetonide suspension (100 mg/ml).The mean logMAR BCVA,CMT before and 1,3 months after the treatment between the two groups were observed and compared.Results On 1 and 3 months after treatment,the mean logMAR BCVA in the non-ischemic group (0.32±0.25 and 0.27±0.29) were improved compared with ischemic group (0.76±0.37 and 0.41±0.79),the difference was statistically significant (t=5.052,5.240;P<0.05).The mean logMAR BCVA before and after treatment had no statistically significant difference in ischemic group (F=0.516,P>0.05),but had a statistically significant difference in non-ischemic group (F=7.685,P<0.05).On 1 and 3 months after treatment,the mean CMT in the ischemic group were (534.7±223.4),(470.8±234.7) μm,which were lower (127.4 ± 28.28),(191.4 ± 34.55) μm before treatment.In the non-ischemic group,the average CMT was (426.2±188.8),(371.3±200.6) μm,which were lower (103.1±33.1),(164.9±49.6) μm.There were statistically significant differences in the mean CMT between the ischemic group and the non ischemic group (F=17.040,10.360;P<0.05).In non-ischemic group,CMT had a bigger reduction compared to the the ischemic group (t=2.056,2.103;P<0.05).The difference of CMT decrease value between two groups was not statistically significant (t=0.560,0.441;P>0.05).On 1 month after the treatment,there were 3 and 5 eyes had a higher intraocular pressure than 21 mmHg (1 mmHg=0.133 kPa) in ischemic and non-ischemic group,respectively;but all of them returned to normal after drug treatment.There were no drugs and ocular injection related complications.Conclusion PSTA of ischemic RVO macular edema can lower the CMT in the short term,but can't significant improve the visual acuity.%目的 观察后Tenon囊下注射曲安奈德(PSTA)治疗缺血型视网膜静脉阻塞(RVO)黄斑水肿的短期临床疗效.方法 回顾性非随机对照临床研究.通过眼底彩色照相、荧光素眼底血管造影及光相干断层扫描(OCT)检查确诊的RVO黄斑水肿患者53例53只眼纳入研究.所有患眼均采用国际标准视力表检测最佳矫正视力(BCVA),并将结果转换为最小分辨角对数(logMAR)视力记录.利用OCT自带软件测量患眼黄斑中心凹厚度(CMT).53只眼中,缺血型RVO黄斑水肿(缺血型组)27只眼,平均logMARBCVA为0.82±0.37,平均CMT为(662.1±216.7) μm;非缺血型RVO黄斑水肿(非缺血型组)26只眼,平均logMAR BCVA为0.41±0.23,平均CMT为(548.0±161.9) μm.两组患眼logMAR BCVA、CMT比较,差异有统计学意义(t=4.745、2.258,P<0.05).所有患眼均行单次PSTA治疗,注射曲安奈德悬浮液0.4 ml(含曲安奈德40 mg).对比观察两组患眼治疗后1、3个月logMAR BCVA、CMT与治疗前logMAR BCVA、CMT的异同以及药物、眼部注射相关并发症的发生情况.结果 治疗后1、3个月,缺血型组患眼平均logMAR BCVA分别为0.76±0.37、0.79±0.41;非缺血型组患眼平均logMAR BCVA分别为0.32±0.25、0.27±0.29.非缺血型组患眼平均logMAR BCVA较缺血型组患眼明显提高,差异有统计学意义(t=5.052、5.240,P<0.05).缺血型组患眼治疗前后平均logMAR BCVA比较,差异无统计学意义(F=0.516,P>0.05);非缺血型组患眼治疗前后平均logMAR BCVA比较,差异有统计学意义(F=7.685,P<0.05).治疗后1、3个月,缺血型组患眼平均CMT分别为(534.7±223.4)、(470.8±234.7) μm,较治疗前分别降低(127.4±28.3)、(191.4±34.6) μm.非缺血型组患眼平均CMT分别为(426.2±188.8)、(371.3±200.6)tm,较治疗前分别降低(103.1±33.1)、(164.9±49.6) μm.非缺血型组患眼平均CMT较缺血型组患眼低,差异有统计学意义(t=2.056、2.103,P<0.05);两组患眼之间平均CMT降低值比较,差异均无统计学意义(t=0.560、0.441,P>0.05).缺血型组、非缺血型组患眼治疗前后平均CMT比较,差异均有统计学意义(F=17.040、10.360,P<0.05).治疗后1个月时,缺血型组、非缺血型组分别有3、5只眼眼压>21 mmHg(1 mmHg=0.133 kPa),通过降眼压药物治疗后均恢复正常.所有患眼均未出现眼球破裂、球后出血、上睑下垂和眶蜂窝织炎等与药物、眼部注射相关的并发症.结论 PSTA治疗缺血型RVO黄斑水肿短期内可降低患眼CMT,但对视力无明显改善作用.