CAJ | 학술논문

目的观察曲安奈德注射液玻璃体腔注射(IVI)和Tenon囊下给药(Sti)治疗糖尿病性黄斑水肿的疗效.设计回顾性病例系列.研究对象 37例通过荧光素眼底血管造影(FFA)和相干光断层扫描(OCT)诊断的糖尿病性黄斑水肿患者.方法分别给予一次性曲安奈德(4 mg)玻璃体腔注射(n=19)或三次(0 d、2 w、4 w)Tenon囊下给药(40 mg/次)(n=18).治疗后4、8、12、16、20、24 w复查最佳矫正视力、眼底、眼压、FFA、OCT,评价其疗效.主要指标视力、视网膜黄斑中心凹厚度、眼压.结果 32例患者完成了24周的观察研究.IVI组治疗前及治疗后24周的视力分别为(0.10±0.03)、(0.24±0.06)(F=15.459,P=0.000);黄斑中心凹视网膜厚度分别为(460.73±6.33)μm、(394.53±41.43)μm(F=25.282,P=0.0000).Sti组治疗前及治疗后24周的视力分别为(0.11±0.04)、(0.18±0.07)(F=6.989,P=0.000);黄斑中心凹视网膜厚度分别为(454.76±56.28)μm、(424.94±42.69)μm(F=5.145,P=0.000).同一时间点,IVI的治疗效果较Sti更显著,差异具有统计学意义(P均<0.05).两组患者未出现严重、不可逆转并发症.结论曲安奈德玻璃体腔注射和Tenon囊下多次给药均是治疗糖尿病性黄斑水肿的有效方法;玻璃体腔注射效果更显著,Tenon囊下给药更安全.
목적 관찰곡안내덕주사액파리체강주사(IVI)화Tenon낭하급약(Sti)치료당뇨병성황반수종적료효.설계회고성병례계렬.연구대상 37례통과형광소안저혈관조영(FFA)화상간광단층소묘(OCT)진단적당뇨병성황반수종환자.방법 분별급여일차성곡안내덕(4 mg)파리체강주사(n=19)혹삼차(0 d、2 w、4 w)Tenon낭하급약(40 mg/차)(n=18).치료후4、8、12、16、20、24 w복사최가교정시력、안저、안압、FFA、OCT,평개기료효.주요지표시력、시망막황반중심요후도、안압.결과 32례환자완성료24주적관찰연구.IVI조치료전급치료후24주적시력분별위(0.10±0.03)、(0.24±0.06)(F=15.459,P=0.000);황반중심요시망막후도분별위(460.73±6.33)μm、(394.53±41.43)μm(F=25.282,P=0.0000).Sti조치료전급치료후24주적시력분별위(0.11±0.04)、(0.18±0.07)(F=6.989,P=0.000);황반중심요시망막후도분별위(454.76±56.28)μm、(424.94±42.69)μm(F=5.145,P=0.000).동일시간점,IVI적치료효과교Sti경현저,차이구유통계학의의(P균<0.05).량조환자미출현엄중、불가역전병발증.결론 곡안내덕파리체강주사화Tenon낭하다차급약균시치료당뇨병성황반수종적유효방법;파리체강주사효과경현저,Tenon낭하급약경안전.
Objective To study the efficacy of intravitreous injection (IVI) or sub-Tenaninfusion (STi) of triamcinolone acetonide (TA) for diabetic macular oedema. Design Retrospective cases series. Participants 37 cases (37 eyes) with diabetic macular oedema confirmed by fundus fluorescence angiography (FFA) and optical coherence tomography (OCT). Methods Patients were received 4mg TA by single intravitreous injection or 40mg TA by three times sub-Tenoninfusion at 0d, 2w, 4w. The best corrected visual acuity, fundus examination, intraocular pressure, fundus fluorescence angiography were further analyzed, and the retinal thickness of macular fovea were measured by OCT. Main Outcome Measures The visual acuity, thickness of retinal macular fovea, ocular pressure was measured. Results 32 cases (32 eyes) completed the 24 week followed-up. In group IVI, the visual acuity before and after injection was 0.10±0. 03, 0.24±0.06(F=15.459, P=0.000) respectively; and retinal thickness of macular fovea is(460.73±46.33)μm,(394.53±41.43)μm (F=25. 282, P=0.0000) respectively. But in group STi, the visual acuity before and after injection is 0.11±0.04, 0.18±0.07(F=6.989, P=0.000) accordingly; and retinal thickness of maculur fovea is (454.76±56.28)μm,(424.94±42.69)μm (F=5.145, P=0.000) respectively. There was obvious statistical significance between two methods at same time point(all P<0.05). The serious, irreversible complications had not been found in all patients during follow-up. Conclusion Triamcinolone acetonide by single intravitreous injection or repeatedly sub-Tenoninfasion are good ways to relieve diabetic macular oederna, IVA-TA is more effective, and STi-TA safer. (Ophthaimol CHN, 2009, 18: 246-250)