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[玻璃体内注射曲安奈德的眼部副作用及并发症]

[Ocular side effects and complications of intravitreal triamcinolone acetonide injection].

作者信息

Jaissle G B, Szurman P, Bartz-Schmidt K U

机构信息

Abteilung für Erkrankungen des vorderen und hinteren Augenabschnitts, Universitäts-Augenklinik, Tuebingen.

出版信息

Ophthalmologe. 2004 Feb;101(2):121-8. doi: 10.1007/s00347-003-0975-z.

Abstract

With the advent of intravitreal triamcinolone acetonid injections major focus was assigned to potential ocular side effects. The current discussion is dominated by the potential cytotoxicity of particular biologically incompatible components. Those are regarded as substantial pathogenetic factor of the sterile pseudoendophthalmitis that seems to be avoidable by meticulous purification of the commercially available preparations. Even sustained subretinal or epiretinal deposits disclosed no signs of retinal toxicity. Major ocular side effects comprise temporary corticosteroid glaucoma and progressive cataract formation. Infectious endophthalmitis represents a rare but serious complication that might be set into critical context with hygienic surgical standards applied. Due to steroid-induced immune suppression clinical signs of inflammation might be masked and a proper diagnosis delayed. Other rare complications reported include a transient central retinal artery occlusion, conjunctival ulcerations, retinal detachment and potential reactivation of a cytomegalovirus retinitis. In conclusion, ocular side effects and complications show a wide variety of clinical signs and underlying causal mechanisms. However, the consequences are mostly temporary and show a good response to therapeutic intervention.

摘要

随着玻璃体内注射曲安奈德的出现,主要关注点被放在了潜在的眼部副作用上。当前的讨论主要围绕特定生物不相容成分的潜在细胞毒性展开。这些被视为无菌性假眼内炎的重要致病因素,而通过对市售制剂进行细致纯化似乎可以避免这种情况。即使是持续的视网膜下或视网膜前沉积物也未显示出视网膜毒性迹象。主要的眼部副作用包括暂时性皮质类固醇性青光眼和进行性白内障形成。感染性眼内炎是一种罕见但严重的并发症,可能与所应用的卫生手术标准密切相关。由于类固醇诱导的免疫抑制,炎症的临床体征可能被掩盖,从而延误正确诊断。报告的其他罕见并发症包括短暂性视网膜中央动脉阻塞、结膜溃疡、视网膜脱离以及巨细胞病毒性视网膜炎的潜在复发。总之,眼部副作用和并发症表现出各种各样的临床体征和潜在因果机制。然而,后果大多是暂时的,并且对治疗干预反应良好。

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