Batioğlu Figen, Ozmert Emin, Parmak Neslihan, Celik Selcen
Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, Ankara 06100, Turkey.
Int Ophthalmol. 2007 Oct;27(5):299-306. doi: 10.1007/s10792-007-9072-7. Epub 2007 Apr 24.
To investigate 2-year results of intravitreal triamcinolone acetonide injection for the treatment of diffuse diabetic macular edema unresponsive to previous laser photocoagulation.
The study included 75 eyes of 75 diabetic patients with clinically significant diffuse macular edema that had failed to respond to previous laser photocoagulation. An intravitreal injection of triamcinolone acetonide at the dose of 4 mg/0.1 ml was administered. Best-corrected visual acuity was measured as the logarithm of the minimum angle of resolution (logMAR), and central macular thickness was obtained by optical coherence tomography at each visit. Intraocular pressure and lenticular status were also evaluated. Differences among measurements were evaluated by Friedman two-way analysis of variance by ranks. Mean follow-up period was 24.7 +/- 5.9 months.
The mean central macular thickness, which was obtained 3 days, 1 month, 3 months, 6 months, 9 months, 12 months, 18 months and 24 months postoperatively, was significantly different from the baseline measurement (P < 0.001). Mean best-corrected logMAR visual acuity improved significantly from baseline at the 1- month and 3-month follow-up intervals (P < 0.05), but there was no significant change at the 6- month, 9-month, 12-month, 18-month or 24-month follow-up periods (P > 0.05). During the follow-up, 29 (38.7%) eyes received re-injection of intravitreal triamcinolone. Twenty-one (28%) eyes developed intraocular pressure values higher than 21 mmHg, and 18 (24%) eyes developed cataract. Thirteen (17.3%) eyes required cataract and/or glaucoma surgery.
In refractory diabetic macular edema, intravitreal triamcinolone effectively reduces foveal thickness and improves visual acuity in the short term, but with the extended follow-up, the number of recurrences and steroid-related complications were shown to increase. Nevertheless, it may be a therapeutic option in some patients that do not respond to previous laser photocoagulation.
研究玻璃体内注射曲安奈德治疗既往激光光凝治疗无效的弥漫性糖尿病性黄斑水肿的2年疗效。
本研究纳入75例糖尿病患者的75只眼，这些患者患有具有临床意义的弥漫性黄斑水肿，且对既往激光光凝治疗无反应。给予玻璃体内注射4mg/0.1ml曲安奈德。每次就诊时，以最小分辨角对数（logMAR）测量最佳矫正视力，并通过光学相干断层扫描获得中心黄斑厚度。同时评估眼压和晶状体状态。测量值之间的差异采用Friedman双向秩方差分析进行评估。平均随访期为24.7±5.9个月。
术后3天、1个月、3个月、6个月、9个月、12个月、18个月和24个月获得的平均中心黄斑厚度与基线测量值有显著差异（P<0.001）。在随访1个月和3个月时，平均最佳矫正logMAR视力较基线有显著改善（P<0.05），但在随访6个月、9个月、12个月、18个月或24个月时无显著变化（P>0.05）。随访期间，29只眼（38.7%）接受了玻璃体内曲安奈德再次注射。21只眼（28%）眼压升高超过21mmHg，18只眼（24%）发生白内障。13只眼（17.3%）需要进行白内障和/或青光眼手术。
在难治性糖尿病性黄斑水肿中，玻璃体内注射曲安奈德可在短期内有效降低黄斑中心凹厚度并提高视力，但随着随访时间延长，复发次数和类固醇相关并发症会增加。尽管如此，对于一些对既往激光光凝治疗无反应的患者，它可能是一种治疗选择。
