Kawashima Hiroko, Mizukawa Kenichi, Kiryu Junichi
Department of Ophthalmology, Kawasaki Medical School, Okayama, Japan.
Clin Ophthalmol. 2012;6:1307-14. doi: 10.2147/OPTH.S34631. Epub 2012 Aug 10.
The purpose of this retrospective chart review was to evaluate factors associated with improvement of visual acuity after a single sub-Tenon injection of triamcinolone acetonide in patients with diabetic macular edema.
We reviewed the medical records for 63 consecutive eyes with diabetic macular edema treated by sub-Tenon injection of triamcinolone acetonide and assessed at 2 months postoperatively. We evaluated changes in morphology, foveal photoreceptor status, and parafoveal cystic change, and also measured the central retinal thickness and macular volume. The association of these factors with improvement of vision (logarithm of the minimum angle of resolution, logMAR) was investigated.
Eyes were classified as having cystoid macular edema (CME, n = 52), serous retinal detachment (n = 24), or diffuse diabetic macular edema (n = 4). In eyes with CME, the mean logMAR of visual acuity improved significantly (P = 0.003) from 0.35 ± 0.31 at baseline to 0.29 ± 0.29 after 2 months. However, there was no significant improvement of visual acuity in the eyes with serous retinal detachment or diffuse diabetic macular edema after sub-Tenon injection of triamcinolone acetonide (P = 0.549 and P = 0.545, respectively). The central retinal thickness and macular volume were both reduced significantly after sub-Tenon injection of triamcinolone acetonide in eyes with CME and serous retinal detachment. However, improvement of visual acuity in the eyes with CME was not correlated with the reduction of central retinal thickness or macular volume. Parafoveal cystic changes showed significant improvement after sub-Tenon injection of triamcinolone acetonide in eyes with CME. Photoreceptor status was significantly associated with the visual prognosis in eyes with CME, but not in eyes with serous retinal detachment.
Visual acuity improved significantly after sub-Tenon injection of triamcinolone acetonide without photoreceptor recovery in eyes with CME. Improvement of parafoveal cystic changes in the eyes with CME suggests that bipolar cells or their accessory cells might have displayed functional recovery.
本回顾性病历审查的目的是评估单次经颞下注射曲安奈德治疗糖尿病性黄斑水肿患者后视力改善的相关因素。
我们回顾了63例连续经颞下注射曲安奈德治疗糖尿病性黄斑水肿的患者的病历，并在术后2个月进行评估。我们评估了形态学、黄斑中心凹光感受器状态和黄斑旁囊性改变的变化，并测量了视网膜中央厚度和黄斑体积。研究了这些因素与视力改善（最小分辨角对数，logMAR）之间的关联。
眼睛被分类为患有黄斑囊样水肿（CME，n = 52）、浆液性视网膜脱离（n = 24）或弥漫性糖尿病性黄斑水肿（n = 4）。在患有CME的眼睛中，视力的平均logMAR从基线时的0.35±0.31显著提高（P = 0.003）至2个月后的0.29±0.29。然而，经颞下注射曲安奈德后，浆液性视网膜脱离或弥漫性糖尿病性黄斑水肿的眼睛视力没有显著改善（分别为P = 0.549和P = 0.545）。在患有CME和浆液性视网膜脱离的眼睛中，经颞下注射曲安奈德后视网膜中央厚度和黄斑体积均显著降低。然而，患有CME的眼睛视力的改善与视网膜中央厚度或黄斑体积的降低无关。在患有CME的眼睛中，经颞下注射曲安奈德后黄斑旁囊性改变有显著改善。光感受器状态与患有CME的眼睛的视觉预后显著相关，但与浆液性视网膜脱离的眼睛无关。
在患有CME的眼睛中，经颞下注射曲安奈德后视力显著改善，而光感受器未恢复。患有CME的眼睛中黄斑旁囊性改变的改善表明双极细胞或其辅助细胞可能已经表现出功能恢复。
