Er Hamdi, Yilmaz Harun
Department of Ophthalmology, Inonu University Turgut Ozal Medical Center, Malatya, Turkey.
Ophthalmologica. 2005 Nov-Dec;219(6):394-400. doi: 10.1159/000088385.
The purpose of this study was to evaluate the safety and efficacy of intravitreal triamcinolone acetonide injection in patients with diffuse diabetic macular edema. We also compared the effect of intravitreal triamcinolone with macular grid laser photocoagulation in macular edema.
Thirty patients with diabetic diffuse macular edema unresponsive to grid laser photocoagulation for at least 4 months received 0.1 ml (4 mg/ml) intravitreal triamcinolone acetonide (Kenakort-A) injection as treatment. This study group was compared with a control group of 30 patients (30 eyes) who had undergone grid laser macular coagulation. Mean follow-up time was 17 months (range 14-24 months) in the study group and 19 months (range 16-24 months) in the control group.
In the study group, mean improvement in visual acuity measured 3.8, 3.4, 0.9 and 0.2 Snellen lines at the follow-up intervals of 1, 3, 6 and 12 months, respectively. Improvement in visual acuity was statistically significant only at 1 month (p = 0.002) and 3 months (p = 0.003) after injection. Visual acuity was significantly (p < 0.05) better in the study group than the control group at 1 and 3 months. Overall, 6 of 30 eyes (20%) required a second injection and 3 eyes (10%) a third due to regression in visual acuity. Towards the end of the follow-up period, the visual acuity decreased to almost baseline levels. Elevation of intraocular pressure was found in 4 patients and controlled with topical antiglaucomatosis treatment. Sterile endophthalmitis was detected in only one eye. No eye exhibited cataract progression during the follow-up period.
Intravitreal injection of triamcinolone may be beneficial for temporarily increasing visual acuity in patients with diabetic diffuse macular edema who are unresponsive even to grid laser photocoagulation. But the regression of visual acuity looks inevitable in the long term after injection. Therefore, repeated injections with/without increasing doses might be required for the stabilization of visual acuity.
本研究旨在评估玻璃体内注射曲安奈德对糖尿病性黄斑弥漫性水肿患者的安全性和有效性。我们还比较了玻璃体内注射曲安奈德与黄斑格栅激光光凝治疗黄斑水肿的效果。
30例糖尿病性黄斑弥漫性水肿患者，对格栅激光光凝治疗至少4个月无反应，接受0.1 ml（4 mg/ml）玻璃体内注射曲安奈德（康宁克通-A）治疗。该研究组与30例接受格栅激光黄斑光凝治疗的患者（30只眼）组成的对照组进行比较。研究组平均随访时间为17个月（范围14 - 24个月），对照组为19个月（范围16 - 24个月）。
在研究组中，随访1、3、6和12个月时，视力平均改善分别为3.8、3.4、0.9和0.2 Snellen行。视力改善仅在注射后1个月（p = 0.002）和3个月（p = 0.003）有统计学意义。在1个月和3个月时，研究组视力明显（p < 0.05）优于对照组。总体而言，30只眼中有6只眼（20%）因视力下降需要第二次注射，3只眼（10%）需要第三次注射。随访期末，视力降至几乎基线水平。4例患者眼压升高，经局部抗青光眼治疗得到控制。仅一只眼检测到无菌性眼内炎。随访期间无眼出现白内障进展。
玻璃体内注射曲安奈德可能有利于暂时提高对格栅激光光凝治疗无反应的糖尿病性黄斑弥漫性水肿患者的视力。但注射后长期来看视力下降似乎不可避免。因此，可能需要反复注射（无论是否增加剂量）以稳定视力。
