Kim Min Woo, Moon Haein, Yang Sung Jae, Joe Soo Geun
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Ophthalmology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Korean J Ophthalmol. 2016 Feb;30(1):25-31. doi: 10.3341/kjo.2016.30.1.25. Epub 2016 Jan 21.
To evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure.
Patients with DME and central subfield thickness (CST) >300 µm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after ≥3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography.
Forty eyes of 34 patients were included. The average baseline CST was 476 µm. The average CST decreased to 368 µm at 2 months, 374 µm at 4 months, and 427 µm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected.
Posterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.
评估玻璃体内注射贝伐单抗（IVB）失败后，后Tenon囊下注射曲安奈德对难治性糖尿病性黄斑水肿（DME）的疗效。
回顾性纳入DME且中心子野厚度（CST）>300 µm且对IVB注射无反应的患者。具体而言，我们纳入了被诊断为难治性DME且在1至2次IVB注射后CST增加或连续≥3次IVB注射后未降低的患者。一名临床医生将20 mg曲安奈德注入后Tenon囊下间隙。所有患者在基线时以及基线后2、4和6个月接受眼科检查。检查包括Snellen视力、眼压和光谱域光学相干断层扫描。
纳入34例患者的40只眼。平均基线CST为476 µm。平均CST在2个月时降至368 µm，4个月时降至374 µm，6个月时降至427 µm（所有结果p<0.001，Wilcoxon符号秩检验）。平均眼压在2个月时从15.50 mmHg升至16.92 mmHg，但在4个月时降至16.30 mmHg，6个月时降至15.65 mmHg。最小分辨角对数视力在2个月时从0.56提高到0.50（p=0.023），4个月时为0.50（p=0.083），6个月时为0.48（p=0.133，Wilcoxon符号秩检验）。未检测到并发症。
后Tenon囊下注射曲安奈德是一种有效且安全的治疗方法，可降低IVB难治性DME的CST。
