玻璃体内注射曲安奈德治疗糖尿病性黄斑水肿：功能和解剖学结果

Selim Kocabora M, Kucuksahin H, Gulkilik G, Taskapili M, Yilmazli C, Engin G

Service d'Ophtalmologie, Hôpital Académique de Vakif Gureba, Istanbul, Turkey.

J Fr Ophtalmol. 2007 Jan;30(1):32-8. doi: 10.1016/s0181-5512(07)89547-7.

PURPOSE

This prospective study aimed to investigate the effectiveness and safety of intravitreal triamcinolone acetonide (TA) injection in diabetic macular edema unresponsive to an initial argon laser photocoagulation procedure.

MATERIAL

and methods: Fifty-six eyes of fifty patients were included in this study. All the eyes had refractory and clinically significant diabetic macular edema with a central macular thickness (CMT) greater than 300 microm. All the eyes were injected 4 mg/0.1 ml TA intravitreally. The main outcome parameters were best corrected visual acuity (BCVA) and CMT. Elevation of intraocular pressure (IOP) and other potential complications were monitored carefully. All the patients were followed at least 9 months.

RESULTS

Preinjection mean BCVA was 0.128+/-0.11 and statistically significant improvement in BCVA started in the 1st week and was observed during the first 6 months of the follow-up period. BCVA reached 0.289+/-0.19 at the 2nd month and decreased gradually to 0.169+/-0.1 at the 9th month. However, clinically significant improvement after TA injection in BCVA (> or =0.2) was observed in 50%, 67.8%, 67.8%, 28.5%, and 12.5% of the eyes in the 1st, 2nd, 3rd, 6th, and 9th months, respectively. The central macular thickness measured by OCT, which was reduced by 45% at the 3rd month, returned nearly to its initial level at the 9th month. High IOP was observed in 35.7% of eyes and appeared between the 1st week and the 2nd month. Other complications were cataract development and progression (7.1%), pseudoendophthalmitis (3.56%), and bacterial endophthalmitis (1.78%).

CONCLUSION

Intravitreal TA injection is a relatively safe and beneficial therapeutic method for intractable diabetic macular edema. The recurrence of edema warrants reinjections, even though the risk of complication is higher, especially infectious endophthalmitis, which might be devastating. Further studies should be conducted with newer, slow corticosteroid release methods such as intravitreal devices in the treatment of diabetic macular edema.

目的

本前瞻性研究旨在探讨玻璃体内注射曲安奈德（TA）治疗对初始氩激光光凝治疗无反应的糖尿病性黄斑水肿的有效性和安全性。

材料与方法

本研究纳入了50例患者的56只眼。所有患眼均有难治性且具有临床意义的糖尿病性黄斑水肿，中心黄斑厚度（CMT）大于300微米。所有患眼均玻璃体内注射4毫克/0.1毫升TA。主要观察指标为最佳矫正视力（BCVA）和CMT。仔细监测眼压（IOP）升高及其他潜在并发症。所有患者至少随访9个月。

结果

注射前平均BCVA为0.128±0.11，BCVA在第1周开始有统计学意义的改善，并在随访的前6个月持续观察到。第2个月时BCVA达到0.289±0.19，第9个月逐渐降至0.169±0.1。然而，TA注射后BCVA临床显著改善（≥0.2）的患眼比例在第1、2、3、6和9个月分别为50%、67.8%、67.8%、28.5%和12.5%。通过光学相干断层扫描（OCT）测量的中心黄斑厚度在第3个月减少了45%，在第9个月几乎恢复到初始水平。35.7%的患眼出现高眼压，且在第1周和第2个月之间出现。其他并发症包括白内障发展和进展（7.1%）、假性眼内炎（3.56%）和细菌性眼内炎（1.78%）。