Venkatesh Pradeep, Kumar Chandra Shekhar, Abbas Zahir, Garg Satpal
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Ocul Immunol Inflamm. 2008 Sep-Oct;16(5):217-23. doi: 10.1080/09273940802209153.
To compare the safety and efficacy of different methods of posterior subtenon (PST) injection of corticosteroids in the treatment of cystoid macular edema secondary to intermediate uveitis.
Prospective comparative randomized interventional study.
A total number of 30 eyes with cystoid macular edema secondary to intermediate uveitis were examined.
Patients were randomized into 3 treatment groups of 10 eyes each. Each group received PST injection of triamcinolone acetonide 0.5 mL (20 mg) by one of three methods: cannula method (group 1), Smith and Nozik method (group 2), or orbital floor injection method (group 3). Patients underwent Snellen's and ETDRS visual acuity (VA) testing, clinical evaluation, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA) at baseline and follow-up visits.
Changes in Snellen and ETDRS VA, OCT retinal thickness and assessments of safety were recorded in follow-up visits.
Postintervention patients were followed up at the 1st, 2nd, 6th, and 12th weeks. Statistically significant (p = .00) improvement in VA was present in group1 from 0.25 +/- 0.08 (mean +/- standard deviation) to 0.75 +/- 0.24, in group 2 from 0.29 +/- 0.12 to 0.78 +/- 0.23, and in group 3 from 0.24 +/- 0.10 to 0.72 +/- 0.27. Statistically significant decrease in OCT central macular thickness (43.97% in group 1, 32.46% in group 2, and 29.75% in group 3) was noted at 12 weeks. However, the difference between individual groups at each visit did not reach statistical significance. Steroid-induced rise in intraocular pressure was observed in all the three groups with no statistical difference between individual groups.
The different methods of PST injection are equally efficacious in terms of improving visual acuity. However, the cannula method achieves the greatest quantitative reduction in macular thickness. As the cannula method is as efficacious as Smith and Nozik method it may be a preferable method to deliver posterior subtenon injection of corticosteroids.
比较后Tenon囊下（PST）注射皮质类固醇的不同方法治疗中间葡萄膜炎继发黄斑囊样水肿的安全性和有效性。
前瞻性比较随机干预研究。
共检查了30只中间葡萄膜炎继发黄斑囊样水肿的眼睛。
患者被随机分为3个治疗组，每组10只眼。每组通过以下三种方法之一接受PST注射0.5 mL（20 mg）曲安奈德：套管法（第1组）、Smith和Nozik法（第2组）或眶底注射法（第3组）。患者在基线和随访时接受Snellen视力和ETDRS视力（VA）测试、临床评估、光学相干断层扫描（OCT）和眼底荧光血管造影（FFA）。
随访时记录Snellen和ETDRS视力、OCT视网膜厚度的变化以及安全性评估。
干预后患者在第1、2、6和12周进行随访。第1组视力从0.25±0.08（平均值±标准差）显著提高（p = 0.00）至0.75±0.24，第2组从0.29±0.12提高至0.78±0.23，第3组从0.24±0.10提高至0.72±0.27。在12周时，观察到OCT中心黄斑厚度显著降低（第1组为43.97%，第2组为32.46%，第3组为29.75%）。然而，每次随访时各小组之间的差异未达到统计学显著性。在所有三组中均观察到类固醇诱导的眼压升高，各小组之间无统计学差异。
PST注射的不同方法在提高视力方面同样有效。然而，套管法在黄斑厚度的定量减少方面最为显著。由于套管法与Smith和Nozik法同样有效，它可能是进行后Tenon囊下皮质类固醇注射的首选方法。
