Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Division of Biostatistics, Graduate Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2017 Aug;116(8):599-605. doi: 10.1016/j.jfma.2016.09.014. Epub 2016 Oct 27.
BACKGROUND/PURPOSE: To analyze the prognostic factors for ocular hypertension after posterior subtenon injection of triamcinolone acetonide (PSTA) for the treatment of diabetic macular edema (DME).
Patients who received PSTA for DME from January 2006 to December 2011 were enrolled retrospectively and were followed until December 2012 in one hospital. Modified Cox regression models were used to analyze the factors associated with ocular hypertension, which was defined as an intraocular pressure>21 mmHg after PSTA.
A total of 180 PSTA injections were given to 114 eyes from 73 adults with DME. During a mean follow-up of 50.4 weeks after each injection, ocular hypertension occurred in 20.6% of injections (28.1% of eyes). Treatment-naïve patients with proliferative diabetic retinopathy (PDR) had a higher risk of ocular hypertension after PSTA than those with nonproliferative diabetic retinopathy (NPDR) [hazard ratio (HR)=3.255, p=0.030]. Intravitreal injection of bevacizumab (IVB) before PSTA had a significant effect in lowering the risk of ocular hypertension after PSTA in patients with PDR who had received panretinal photocoagulation (PRP) (HR=0.107, p=0.035). Both prompt PRP and IVB following PSTA had a protective effect against ocular hypertension in treatment-naïve patients with PDR (HR=0.086, p=0.0002 and HR=0.155, p=0.049, respectively).
Treatment-naïve patients with PDR had a higher risk of ocular hypertension after PSTA than those with NPDR. Bevacizumab and prompt PRP both had a protective effect against ocular hypertension after PSTA in patients with PDR.
背景/目的：分析曲安奈德后Tenon 下注射（PSTA）治疗糖尿病黄斑水肿（DME）后眼压升高的预后因素。
回顾性纳入 2006 年 1 月至 2011 年 12 月期间在一家医院接受 PSTA 治疗 DME 的患者，并随访至 2012 年 12 月。采用改良 Cox 回归模型分析与眼压升高相关的因素，眼压升高定义为 PSTA 后眼压>21mmHg。
共有 73 例成人 DME 患者的 114 只眼接受了 180 次 PSTA 注射。在每次注射后的平均 50.4 周随访期间，20.6%的注射（28.1%的眼）发生了眼压升高。与非增生性糖尿病视网膜病变（NPDR）相比，初治增生性糖尿病视网膜病变（PDR）患者 PSTA 后眼压升高的风险更高[风险比（HR）=3.255，p=0.030]。在接受全视网膜光凝（PRP）的 PDR 患者中，PSTA 前玻璃体腔内注射贝伐单抗（IVB）可显著降低 PSTA 后眼压升高的风险（HR=0.107，p=0.035）。PSTA 后即刻行 PRP 和 IVB 对初治 PDR 患者的眼压升高均有保护作用（HR=0.086，p=0.0002 和 HR=0.155，p=0.049）。
与 NPDR 相比，初治 PDR 患者 PSTA 后眼压升高的风险更高。贝伐单抗和及时行 PRP 均可降低 PDR 患者 PSTA 后眼压升高的风险。
