Koga Tomoyo, Mawatari Yuki, Inumaru Junko, Fukushima Mikiko, Tanihara Hidenobu
Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, Japan.
Graefes Arch Clin Exp Ophthalmol. 2005 Dec;243(12):1247-52. doi: 10.1007/s00417-005-0045-0. Epub 2005 Jul 15.
To evaluate the efficacy and safety of trans-Tenon's retrobulbar triamcinolone acetonide (TA) infusion for the treatment of refractory diabetic macular edema (DME) after vitrectomy.
After topical anesthesia, 20 eyes from 20 patients with persistent DME after pars plana vitrectomy were treated with trans-Tenon's retrobulbar infusion of 40 mg TA through an inferotemporal approach. The mean duration (+/-SD) between vitrectomy and trans-Tenon's retrobulbar TA infusion was 11.4+/-7.9 months. The mean follow-up period (+/-SD) after trans-Tenon's retrobulbar TA infusion was 13.3+/-2.8 months.
At 1 week after trans-Tenon's retrobulbar TA infusion, the mean central retinal thickness (+/-SD) measured by optical coherence tomography was 381+/-99 mum, which was a statistically significant decrease in comparison with the preoperative thickness (555+/-112 mum) (P<0.001). Additional trans-Tenon's retrobulbar TA infusions were performed in ten eyes (50%), due to the recurrence of DME at 6.6+/-3.0 months after the first TA infusion. At the final examination, macular edema resolved in 13 (65%), improved in four (20%), and remained unchanged in three (15%) of the 20 eyes. At 1 month after trans-Tenon's retrobulbar TA infusion, the mean laser flare value (+/-SD) was 9.6+/-3.0 photon/ms, which was a statistically significant decrease in comparison with the preoperative value (15.5+/-5.9 photon/ms) (P<0.01). Furthermore, in ten eyes (50%) with recurrent DME, re-elevated laser flare values were observed prior to the recurrence of DME. The final best-corrected Snellen visual acuity improved by two or more lines in nine eyes (45%), and remained unchanged in 11 eyes (55.0%). IOP elevation equal to or higher than 21 mmHg was observed in three (15%) of the 20 eyes with TA infusion, and was controlled by topical medications. No other injection-related complications were observed.
Trans-Tenon's retrobulbar TA infusion is an effective and safe method for the treatment of refractory DME, which is present even after vitrectomy.
评估经巩膜Tenon囊下注射曲安奈德（TA）治疗玻璃体切除术后难治性糖尿病性黄斑水肿（DME）的疗效和安全性。
在表面麻醉下，对20例玻璃体切除术后持续性DME患者的20只眼，通过颞下途径经巩膜Tenon囊下注射40mg TA。玻璃体切除术与经巩膜Tenon囊下TA注射之间的平均时间（±标准差）为11.4±7.9个月。经巩膜Tenon囊下TA注射后的平均随访期（±标准差）为13.3±2.8个月。
经巩膜Tenon囊下TA注射后1周，光学相干断层扫描测量的平均中心视网膜厚度（±标准差）为381±99μm，与术前厚度（555±112μm）相比有统计学显著降低（P<0.001）。由于首次TA注射后6.6±3.0个月DME复发，10只眼（50%）进行了额外的经巩膜Tenon囊下TA注射。在最后一次检查时，20只眼中13只（65%）黄斑水肿消退，4只（20%）改善，3只（15%）不变。经巩膜Tenon囊下TA注射后1个月，平均激光散射值（±标准差）为9.6±3.光子/毫秒，与术前值（15.5±5.9光子/毫秒）相比有统计学显著降低（P<0.01）。此外，在10只（50%）DME复发的眼中，在DME复发前观察到激光散射值再次升高。最后最佳矫正视力在9只眼（45%）提高了两行或更多，11只眼（55.0%）保持不变。20只接受TA注射的眼中有3只（15%）眼压升高至21mmHg或更高，并通过局部用药得到控制。未观察到其他与注射相关的并发症。
经巩膜Tenon囊下TA注射是治疗即使在玻璃体切除术后仍存在的难治性DME的一种有效且安全的方法。
