球后注射曲安奈德治療視網(wǎng)膜分支靜脈阻塞繼發(fā)黃斑水腫

1、球后注射曲安奈德治療視網(wǎng)膜分支靜脈阻塞繼發(fā)黃斑水腫         11-04-15 11:36:00     編輯：studa20                 作者：高云霞，劉方毅，趙軍，王赟，王強(qiáng)【摘要】  目的 評(píng)價(jià)球后注射曲安奈德(triamcinolone acetonide,TA)治療視網(wǎng)膜分

2、支靜脈阻塞（branch retinal vein occlusion,BRVO）繼發(fā)黃斑水腫的有效安全性。方法 對(duì)27 例（31 眼）RVO 繼發(fā)的嚴(yán)重黃斑水腫患者，患眼行球后注射曲安奈德40mg/1ml，觀察治療前和治療后1月、3月、6月時(shí)患者的最佳矯正視力、眼壓、眼內(nèi)炎性反應(yīng)、晶體、眼底改變，光學(xué)相干斷層掃描（opticalcoherenttomography，OCT）測(cè)定黃斑區(qū)視網(wǎng)膜厚度變化，F(xiàn)FA檢查眼底熒光造影改變。結(jié)果 所有31眼中，有 25眼（80.64%）視力提高，4眼(12.9%)視力不變，2眼復(fù)發(fā)行玻璃體腔內(nèi)注射TA 。視力治療前為0.11±0.19,治療后1月

3、、3月、6月時(shí)分別為：0.36±0.32；0.56±0.28；0.65±0.35。黃斑中心凹平均厚度治療前為582±139m，治療后1月、3月、6月時(shí)分別為：329±119m；207±58m；175±36m。治療前后比較差異有統(tǒng)計(jì)學(xué)意義（0.05）。31眼中注射后1、3、6月分別有3眼(9.6%)、7眼(22.5%)和2眼(6.4%)眼壓增高，經(jīng)局部藥物短期治療后恢復(fù)正常。所有患眼未出現(xiàn)球后出血、眼內(nèi)炎、白內(nèi)障、視網(wǎng)膜脫離等并發(fā)癥。結(jié)論 球后注射曲安奈德可安全有效地治療 BRVO 繼發(fā)的黃斑水腫。 【關(guān)鍵詞】  視

4、網(wǎng)膜分支靜脈阻塞 曲安奈德 黃斑水腫 治療ABSTRACT  Objective  To evaluate the safe effect of retrobulbar injection of triaminolone acetonide (TA) in treating macular edema secondary to branch retinal vein occlusion (BRVO).Methods  31 affected eyes of 27 cases with serious macular edema secondary to BRVO

5、received retroblbar injection of TA,40 mg/1 ml;the best corrected vision,introaocular pressure,inflammatory reaction,crystal and fundus changes of the patients before treatment and at the intervals of 1 month,3 months and 6 months after treatment were observed;optical coherent tomography (OCT) was a

6、pplied to detect the changes of macular retinal thickness,and fundus fluorescein angiography was made as well.Results    Out of the 31 eyes,25 eyes (80.64%) had vision improvement while the visions of 4 eyes remained the same,intravitreal injection of TA was performed to 2 cases with

7、reoccurrence;the average vision before treatment was 0.11±0.19 and that in the 1st,the 3rd and the 6th month after treatment was 0.36±0.32,0.56±0.28 and 0.65±0.35 respectively;the average thickness of macular central fovea before treatment was 582±139 m and that in the 1st,t

8、he 3rd and the 6th month after treatment was 329±119 m,207±58 m and 175±36 m respectively;the difference was of statistical significance (0.05);the introaocular pressure of 3 eyes (9.6%) out of the 31 eyes increased 1month after the injection as well as 7 eyes (22.5%) 3 months after t

9、he injection and 2 eyes (6.4%) 6 months after the injection,they all became normal after local drug administration for a short time;no such complications as retrobulbar hemorrhage,endophthalmitis,cataract or retinal etachment occurred in all the affected eyes.Conclusions    Retrobulba

10、r injection of TA is of safety and effect in treating macular edema secondary to BRVOKEYWORDS  branch retinal vein occlusion (BRVO)             triamcinolone acetonide           &#

11、160;      Macular edema therapy1  對(duì)象與方法1.1  對(duì)象  選擇從2005年11月2007年5月期間來(lái)我院就診主訴視力下降、視物變形,檢查眼底并經(jīng)FFA、OCT確診為視網(wǎng)膜分支靜脈阻塞繼發(fā)黃斑水腫,同時(shí)排除青光眼和高眼壓、糖尿病的患者。所有患者及家屬知情同意并簽訂球后注射TA治療知情同意書(shū)，后進(jìn)行球后注射TA 治療。    本組選擇符合納入標(biāo)準(zhǔn)的患者共27例31只眼接受球后注射TA治療。27例患者中有男性16例19只眼,女性11例12只眼,

12、球后注射TA后隨訪觀察68月。1.2  檢查方法和項(xiàng)目  患者分別于術(shù)前和術(shù)后1月、3月、6月進(jìn)行下列檢查,均由同一熟練技術(shù)人員完成。1.2.1  常規(guī)檢查  檢查裸眼及矯正視力(標(biāo)準(zhǔn)對(duì)數(shù)視力表),裂隙燈眼前節(jié)檢查,散瞳直接檢眼鏡眼底檢查,Topcon非接觸式式眼壓計(jì)測(cè)量眼壓。1.2.2  光學(xué)相干斷層掃描(optical coherence tomography,OCT)檢查  使用Zeiss公司Humphrey光學(xué)相干斷層掃描儀(OCT-3000型)進(jìn)行黃斑區(qū)視網(wǎng)膜厚度檢測(cè):測(cè)量部位選擇黃斑中心凹,測(cè)量距離指色素上皮光帶內(nèi)側(cè)至神經(jīng)

13、上皮光帶內(nèi)側(cè)的距離。對(duì)每只眼行通過(guò)黃斑中心凹六個(gè)方向,掃描長(zhǎng)度為6.0mm，利用計(jì)算機(jī)圖像分析系統(tǒng)由同一操作者進(jìn)行中心凹視網(wǎng)膜神經(jīng)上皮層厚度的人工手動(dòng)測(cè)量并取兩值的平均值作為該眼的神經(jīng)上皮層厚度值。1.2.3  眼底熒光造影(fundus fluorescein angiography,FFA)  所有觀察對(duì)象均散瞳用Topcon TRC.50X眼底熒光造影系統(tǒng)進(jìn)行FFA檢查,根據(jù)結(jié)果對(duì)黃斑水腫分為以下幾型:（1）無(wú)滲漏型,即造影自始至終黃斑區(qū)無(wú)熒光素滲漏。（2）局部水腫型,晚期滲漏僅占據(jù)黃斑的局部(滲漏范圍在2個(gè)象限內(nèi))。（3）彌漫水腫型,廣泛熒光素滲漏占據(jù)整個(gè)黃斑區(qū)(滲

14、漏范圍大于2個(gè)象限,包括囊樣水腫)。選擇黃斑水腫者作為研究對(duì)象并在每次隨訪時(shí)進(jìn)行FFA檢查。1.2.4  球后注射TA的方法    注射前患眼眼瞼局部皮膚碘伏消毒，注射時(shí)用商品TA混懸液1ml (意大利，Lisapharma S.P.A公司),內(nèi)含曲安奈德40mg,用2ml注射器抽取1mlTA,囑患者向鼻上側(cè)看，把4cm長(zhǎng)的針頭由眶下緣中1/3與外1/3交界處稍上方的皮膚面進(jìn)針，先向后進(jìn)針約1cm，再轉(zhuǎn)向內(nèi)上方徐徐推進(jìn)，深入眶內(nèi)直達(dá)球后。針刺深度約3.5cm，回抽并確定針尖不在血管內(nèi)，即注射40mg TA。1.3  統(tǒng)計(jì)分析方法  球后注射TA 治療前后視力、黃斑中