Antcliff R J, Spalton D J, Stanford M R, Graham E M, ffytche T J, Marshall J
GKT Department of Ophthalmology, Rayne Institute, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, England, UK.
Ophthalmology. 2001 Apr;108(4):765-72. doi: 10.1016/s0161-6420(00)00658-8.
To investigate the use of intravitreal injection of triamcinolone acetonide (TA) for the treatment of refractory uveitic cystoid macular edema (CME).
Prospective, nonrandomized, self-controlled comparative trial.
Six patients with chronic CME resistant to treatment with systemic steroids, orbital floor steroids, and cyclosporine A. Three patients were followed for more than 1 year, and the other three for between 3 and 9 months.
Injection of 2 mg of TA into the vitreous cavity.
Optical coherence tomography scanning of the fovea before and after injection and logarithmic minimal angle of resolution visual acuity.
Visual acuity, retinal thickness, cystoid space height, and intraocular pressure.
There was complete anatomic resolution of CME in five of the six cases within 1 week after injection. Cystoid spaces began to return between 6 weeks and 3 months after injection. Two patients with longer term follow-up responded to further orbital floor steroid injection and had no CME 1 year later. One patient had raised intraocular pressure develop, requiring a trabeculectomy. Mean improvement in visual acuity after 12 months was 0.27 (range, 0.14-0.42).
Complete anatomic and, to some extent, functional recovery can be induced by intravitreal TA despite long-term refractory inflammatory CME. Optical coherence tomography aids in the management of these cases.
探讨玻璃体内注射曲安奈德（TA）治疗难治性葡萄膜炎性黄斑囊样水肿（CME）的疗效。
前瞻性、非随机、自身对照比较试验。
6例慢性CME患者，对全身用类固醇、眶底类固醇及环孢素A治疗无效。3例患者随访超过1年，另外3例随访3至9个月。
向玻璃体腔注射2mg TA。
注射前后对黄斑中心凹进行光学相干断层扫描，并测量对数最小分辨角视力。
视力、视网膜厚度、囊样间隙高度及眼压。
6例患者中有5例在注射后1周内CME完全解剖复位。囊样间隙在注射后6周～3个月开始复现。2例长期随访患者对进一步的眶底类固醇注射有反应，1年后无CME。1例患者眼压升高，需行小梁切除术。12个月后平均视力改善0.27（范围0.14～0.42）。
尽管存在长期难治性炎性CME，但玻璃体内注射TA可诱导完全解剖复位，并在一定程度上实现功能恢复。光学相干断层扫描有助于这些病例的管理。
