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目的:观察玻璃体腔内曲安奈德(triamcinolone acetonide TA)注射治疗视网膜静脉阻塞引起的黄斑水肿的疗效并进行分析。方法:检眼镜、光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)检查证实的由视网膜静脉阻塞引起的黄斑水肿患者42例42只眼,玻璃体内注射40g/L的TA0.1ml,随访3～6个月,观察视力、眼压、晶状体、炎症反应、眼底情况,OCT观察视网膜厚度改变,FFA观察眼底毛细血管渗漏情况,对视力和视网膜厚度进行随机区组设计方差分析。结果:治疗前视力为0.15±0.16,治疗后3个月,平均视力为0.40±0.27,视力提高3行以上者33眼,提高3行以内者5眼,不变者4眼,与治疗前相比,差异有统计学意义(P<0.05)。治疗前视网膜厚度平均值为(745±241)μm,治疗后为(259±129)μm,与治疗前相比,差异有统计学意义(P<0.05)。42例患眼中,3例治疗后出现眼压一过性升高,未行药物或手术治疗,眼压降至正常范围。因3个月后黄斑水肿复发,再次注药者3眼,其中1例并发白内障,行白内障手术。FFA提示渗漏明显减轻。无玻璃体出血、视网膜脱离和眼内炎等严重并发症。结论:玻璃体腔内注射TA4mg可以明显减轻由静脉阻塞引起的黄斑水肿,并提高患者视力,是一种有效可行的方法。缺血型患者黄斑水肿易复发,可以考虑玻璃体腔内重复注药,但其远期疗效和并发症需进一步观察。
Objective: To observe and analyze the efficacy of intravitreal injection of triamcinolone acetonide TA in the treatment of macular edema caused by retinal vein occlusion. METHODS: Forty-two eyes (42 eyes) of 42 patients with macular edema caused by retinal vein occlusion confirmed by ophthalmoscopy, optical coherence tomography (OCT) and fluorescein angiography (FFA) were injected intravitreally with 40g / L TA 0.1ml, The patients were followed up for 3 to 6 months. Visual acuity, intraocular pressure, lens, inflammatory reaction and ocular fundus were observed. OCT was used to observe the changes of retinal thickness. FFA was used to observe the fundus capillary leakage. The visual acuity and retinal thickness were analyzed by randomized block design. Results: Before treatment, the visual acuity was 0.15 ± 0.16. After 3 months of treatment, the average visual acuity was 0.40 ± 0.27, the visual acuity increased by 3 lines or more in 33 eyes, the increase of 3 eyes within 3 lines and 4 eyes of the same, The difference was statistically significant (P <0.05). The average retinal thickness before treatment was (745 ± 241) μm and (259 ± 129) μm after treatment, which was significantly different from that before treatment (P <0.05). In 42 eyes, the intraocular pressure was transiently elevated in 3 cases after treatment. The intraocular pressure was reduced to the normal range without any medication or surgery. 3 months after the recurrence of macular edema, re-injection of 3 patients, including 1 case of cataract, cataract surgery. FFA prompts significantly reduced leakage. No vitreous hemorrhage, retinal detachment and endophthalmitis and other serious complications. Conclusion: Intravitreal injection of TA4mg can significantly reduce macular edema caused by venous obstruction and improve visual acuity in patients. It is an effective and feasible method. Ischemic macular edema prone to recurrence, repeated injection of vitreous cavity can be considered, but its long-term efficacy and complications need further observation.