曲安奈德玻璃体腔注射联合黄斑格栅样光凝治疗黄斑水肿的临床研究
곡안내덕파리체강주사연합황반격책양광응치료황반수종적림상연구
The combination of triamcinolone acetonide intravitreous injection with macular laser grid photocoagulation in the treatment of macular edema
  • 万方数据
    中华实验眼科杂志 중화실험안과잡지
    CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
    2012年 8期 734-738 ,共5页

    乔宝笛%戴涛%帖彪%陈鹏

    교보적%대도%첩표%진붕

    曲安奈德%玻璃体腔注射%格栅样光凝%黄斑水肿 麯安奈德%玻璃體腔註射%格柵樣光凝%黃斑水腫
    곡안내덕%파리체강주사%격책양광응%황반수종
    Triamcinolone acetonide%Intravitreal injection%Laser grid photocoagulation%Macular edema
    背景 糖皮质激素玻璃体腔注射治疗黄斑水肿的临床效果已得到证实,其代表性药物为曲安奈德.但曲安奈德局部应用联合黄斑格栅样光凝治疗黄斑水肿的疗效及安全性值得关注. 目的 评价曲安奈德玻璃体腔注射联合黄斑格栅样光凝治疗黄斑水肿的疗效及安全性. 方法 采取队列研究试验设计,按照纳入标准收集糖尿病性黄斑水肿或视网膜静脉阻塞性黄斑水肿患者120例120眼,按随机数字表法将患者随机分为试验组和对照组,两组人口基线特征匹配.试验组实施玻璃体腔注射曲安奈德联合黄斑格栅样光凝,对照组仅行黄斑格栅样光凝,分别于术后1周,1、3、6个月行最佳矫正视力、眼压、光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)检查,对检查指标进行组间比较,对试验组术后检测结果与术前值进行比较.结果 与玻璃体腔注射前视力比较,试验组在注射后1周、1、3、6个月视力均有明显提高,差异均有统计学意义(均P=0.000),而对照组治疗后各时间点的视力与治疗前比较差异均无统计学意义(P＞0.05);治疗后各时间点对照组的视力均明显低于试验组,差异均有统计学意义(P=0.037、0.000、0.002、0.046).玻璃体腔注射后各时间点试验组黄斑水肿明显减轻,黄斑中心凹视网膜神经上皮层厚度明显下降,差异均有统计学意义(均P=0.000),而对照组黄斑中心凹视网膜神经上皮层厚度与治疗前比较差异均无统计学意义(P＞0.05),玻璃体腔注射后各时间点试验组黄斑中心凹视网膜神经上皮层厚度均显著低于对照组,差异均有统计学意义(P＜0.05).试验组中7例在玻璃体腔注射后4～6个月黄斑水肿复发,占11.67％;玻璃体腔注射后11例眼压升高至21 mmHg以上,占14.1％. 结论 曲安奈德玻璃体腔注射联合黄斑格栅样光凝可有效治疗黄斑水肿,但少数患者在6个月内出现复发及眼压升高.
    배경 당피질격소파리체강주사치료황반수종적림상효과이득도증실,기대표성약물위곡안내덕.단곡안내덕국부응용연합황반격책양광응치료황반수종적료효급안전성치득관주. 목적 평개곡안내덕파리체강주사연합황반격책양광응치료황반수종적료효급안전성. 방법 채취대렬연구시험설계,안조납입표준수집당뇨병성황반수종혹시망막정맥조새성황반수종환자120례120안,안수궤수자표법장환자수궤분위시험조화대조조,량조인구기선특정필배.시험조실시파리체강주사곡안내덕연합황반격책양광응,대조조부행황반격책양광응,분별우술후1주,1、3、6개월행최가교정시력、안압、광학상간단층소묘(OCT)、형광소안저혈관조영(FFA)검사,대검사지표진행조간비교,대시험조술후검측결과여술전치진행비교.결과 여파리체강주사전시력비교,시험조재주사후1주、1、3、6개월시력균유명현제고,차이균유통계학의의(균P=0.000),이대조조치료후각시간점적시력여치료전비교차이균무통계학의의(P＞0.05);치료후각시간점대조조적시력균명현저우시험조,차이균유통계학의의(P=0.037、0.000、0.002、0.046).파리체강주사후각시간점시험조황반수종명현감경,황반중심요시망막신경상피층후도명현하강,차이균유통계학의의(균P=0.000),이대조조황반중심요시망막신경상피층후도여치료전비교차이균무통계학의의(P＞0.05),파리체강주사후각시간점시험조황반중심요시망막신경상피층후도균현저저우대조조,차이균유통계학의의(P＜0.05).시험조중7례재파리체강주사후4～6개월황반수종복발,점11.67％;파리체강주사후11례안압승고지21 mmHg이상,점14.1％. 결론 곡안내덕파리체강주사연합황반격책양광응가유효치료황반수종,단소수환자재6개월내출현복발급안압승고.
    Background Clinical effectiveness of intavitreal injection of glucocorticosteroid for macular edema has been verified,especially triamcinolone acetonide(TA).However,the efficacy and safety of combination of TA with macular laser grid photocoagulation for macular edema is concerned. Objective This clinical trial was to evaluate the efficacy and safety of intravitreal injection of TA combined with macular laser grid photocoagulation in the treatment of macular edema. Methods A case-cohort study was designed.One hundred and twenty eyes of 120 patients with macular edema from diabetes or retinal vein occlusion were included in this study.The patients were randomized into trial group and control group,with the matched age,course,visual acuity,intraocular pressure (IOP).The patients of the trial group received intravitreal injection of TA combined with macular laser grid photocoagulation,and those of the control group were managed with macular laser grid photocoagulation only.Best corrected visual acuity ( BCVA),optical coherence tomography(OCT),fundus fluorescein angiography(FFA) and IOP were examined before TA injection and 1 week,1 month,3 months,6 months after treatment and compared among different time points between two groups.Written informed consent was obtained from each patient prior to entering this trial. Results Compared with TA injection before,the BCVA was significantly elevated in the trial group 1 week,1 month,3 months and 6 months after TA injection( all P=0.000),however,no obvious improvement of visual acuity was found in the control group before and after treatment at any time point (P＞0.05 ).At various time points,the visual acuity was significantly improved in the trial group than the control group (P =0.037,0.000,0.002,0.046 ).Macular thickness was significantly decreased at various time points after TA injection in comparison with before TA injection in the trial group(all P=0.000),but no significant change in macular thickness in the control group between before and after treatment at any time point( P＞0.05 ).Macular thickness was lower in the trial group compared with the control group at various time points after treatment ( P＜0.05 ).Recurrence of macular edema was seen in 7 eyes ( 1 1.67％ ) 4-6 months,and the IOP raise( ＞21 mmHg)was found in 11 eyes( 14.1％ )after TA injection in the trial group.Conclusions Intravitreal injection of TA combined with macular laser grid photocoagulation can be an effective method in the treatment of macular edema.However,recurrence of macular edema or increase of IOP may occur in a few patients within 6 months after TA injection.A long-term follow-up should be performed for the evaluation of efficacy and safety after intravitreous injection of TA.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문