Lafranco Dafflon M, Tran V T, Guex-Crosier Y, Herbort C P
Hôpital Ophtalmique Jules Gonin, Department of Ophthalmology, University of Lausanne, Switzerland.
Graefes Arch Clin Exp Ophthalmol. 1999 Apr;237(4):289-95. doi: 10.1007/s004170050235.
Posterior sub-Tenon's steroid injections (PSTSI) are a standard drug delivery method used for the treatment of chronic uveitis of the posterior segment. The aim of this study was to analyse the indications, efficacy and complications of PSTSI in the treatment of chronic uveitis.
During the period 1990-1994, 53 (9.5%) of 558 patients (58 eyes) followed up in the uveitis clinic received a total of 162 PSTSI of triamcinolone acetonide 40 mg in the superior quadrants. Indications for treatment were vision inferior or equal to 0.7 and/or intolerable visual disturbance. Only patients in whom PSTSI were the only treatment parameter changed were analysed. Among the main parameters analysed were visual acuity, aqueous laser flare photometry, intraocular pressure (IOP) and complications.
Anatomical location of uveitis was as follows: anterior HLA-B27-related uveitis with CME (1 patient/1 eye), intermediate uveitis (28/32), posterior uveitis (10/10) and panuveitis (14/15). Mean duration of follow-up was 448+/-57 days. Visual acuity improved significantly from 0.40+/-0.03 to 0.79+/-0.07, with 59.4% of eyes having a gain of 2-5 Snellen lines and 18.7% a gain of >5 lines. Mean aqueous flare photometry decreased significantly from 29.6+/-3.5 to 13.6+/-2.2 photons/ms. Mean IOP increased significantly from 13.6+/-0.5 to 18.5+/-0.8 mm Hg with a rise of pressure >8 mm Hg in 23 cases (36%), transient in 16 cases, but chronic in 6 cases, needing filtering surgery. Partial superior ptosis was seen in two cases and cataract progressed in seven cases.
PSTSI are very effective in restoring visual acuity in chronic uveitis of the posterior segment, without systemic complications, but at the expense of intraocular hypertension, a complication that was found more frequently than expected.
后Tenon囊下类固醇注射（PSTSI）是用于治疗后段慢性葡萄膜炎的一种标准给药方法。本研究的目的是分析PSTSI治疗慢性葡萄膜炎的适应证、疗效及并发症。
在1990年至1994年期间，葡萄膜炎门诊随访的558例患者（58只眼）中有53例（9.5%）在上方象限接受了总共162次40mg曲安奈德的PSTSI。治疗适应证为视力低于或等于0.7和/或有无法耐受的视觉干扰。仅分析PSTSI为唯一改变的治疗参数的患者。分析的主要参数包括视力、房水激光闪光光度测定、眼压（IOP）及并发症。
葡萄膜炎的解剖部位如下：伴黄斑囊样水肿（CME）的前HLA - B27相关性葡萄膜炎（1例/1只眼）、中间葡萄膜炎（28例/32只眼）、后葡萄膜炎（10例/10只眼）和全葡萄膜炎（14例/15只眼）。平均随访时间为448±57天。视力从0.40±0.03显著提高至0.79±0.07，59.4%的眼视力提高2 - 5行，18.7%的眼视力提高超过5行。平均房水闪光光度测定从29.6±3.5显著降至13.6±2.2光子/毫秒。平均眼压从13.6±0.5显著升至18.5±0.8mmHg，23例（36%）眼压升高超过8mmHg，16例为短暂性升高，但6例为慢性升高，需要进行滤过手术。2例出现部分上睑下垂，7例白内障进展。
PSTSI在恢复后段慢性葡萄膜炎的视力方面非常有效，无全身并发症，但代价是高眼压，该并发症的发生频率高于预期。
