Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, USP, Ribeirão Preto, Brazil.
Retina. 2010 Apr;30(4):562-9. doi: 10.1097/IAE.0b013e3181c969b4.
The purpose of this study was to compare the effectiveness of intravitreal injection (IVT) versus posterior subtenon infusion (STI) of triamcinolone acetonide performed during phacoemulsification cataract surgery in eyes with refractory diffuse diabetic macular edema.
Twenty-four eyes of 24 patients with refractory diffuse diabetic macular edema scheduled to undergo phacoemulsification cataract surgery were randomly assigned to receive either a 4-mg IVT (n = 12) or a 40-mg STI (n = 12) of triamcinolone acetonide during cataract surgery. Comprehensive ophthalmic evaluation, including best-corrected visual acuity, intraocular pressure, and central macular thickness measured with optical coherence tomography, was performed at baseline and at 1, 4, 8 +/- 1, 12 +/- 2, and 24 +/- 2 weeks postoperatively.
Ten patients from the IVT group and 9 patients from the STI group completed the 24-week study visit. Mean baseline best-corrected visual acuity (logarithm of the minimum angle of resolution) was 20/259 and 20/222 in the IVT and STI groups, respectively (t = 0.41; P = 0.3407). A significant improvement in best-corrected visual acuity was observed only in the IVT group at 4 weeks (mean difference +/- standard error, improved to 20/116; P = 0.0437), 8 weeks (20/110; P = 0.0355), and 12 weeks (20/121; P = 0.0471) postoperatively. There was no significant change from baseline in mean intraocular pressure in either group. Mean +/- standard error baseline central macular thickness was 474.1 +/- 42.4 microm and 490.8 +/- 70.8 microm in the IVT and STI groups, respectively (t = 0.21; P = 0.5807). The central macular thickness reductions after surgery at all study follow-up visits were significantly greater in the IVT group than in the STI group (P < 0.05).
These data suggest that IVT is more effective than STI of triamcinolone acetonide for the management of refractory diffuse diabetic macular edema in eyes undergoing phacoemulsification. Further investigation of a larger number of patients with longer follow-up is necessary to confirm these findings.
本研究旨在比较在白内障超声乳化手术期间行玻璃体内注射（IVT）与后Tenon 下注射（STI）曲安奈德治疗难治性弥漫性糖尿病黄斑水肿的效果。
24 例（24 只眼）计划行白内障超声乳化手术的难治性弥漫性糖尿病黄斑水肿患者随机分为两组，分别在术中接受玻璃体内注射 4mg 曲安奈德（IVT 组，n = 12）或后Tenon 下注射 40mg 曲安奈德（STI 组，n = 12）。在基线时及术后 1、4、8 +/- 1、12 +/- 2、24 +/- 2 周时进行全面眼科评估，包括最佳矫正视力、眼内压和光学相干断层扫描测量的中心黄斑厚度。
IVT 组和 STI 组各有 10 例和 9 例患者完成了 24 周的研究访视。IVT 组和 STI 组的基线时最佳矫正视力（最小分辨角对数）分别为 20/259 和 20/222（t = 0.41；P = 0.3407）。仅 IVT 组在术后 4 周（平均差异 +/- 标准误差，改善至 20/116；P = 0.0437）、8 周（20/110；P = 0.0355）和 12 周（20/121；P = 0.0471）时观察到最佳矫正视力有显著改善。两组的平均眼内压均无明显基线变化。IVT 组和 STI 组的基线时平均中央黄斑厚度分别为 474.1 +/- 42.4 µm 和 490.8 +/- 70.8 µm（t = 0.21；P = 0.5807）。IVT 组在所有研究随访时的中央黄斑厚度减少均显著大于 STI 组（P < 0.05）。
这些数据表明，在接受白内障超声乳化手术的患者中，玻璃体内注射曲安奈德治疗难治性弥漫性糖尿病黄斑水肿比后Tenon 下注射曲安奈德更有效。需要进一步对更多患者进行更长时间的随访以证实这些发现。
