玻璃体切割术结束时玻璃体内注射曲安奈德治疗增生性糖尿病视网膜病变相关玻璃体积血的疗效。

Effect of intravitreal triamcinolone acetonide injection at the end of vitrectomy for vitreous haemorrhage related to proliferative diabetic retinopathy.

机构信息

Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida, Fukui, Japan.

Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan.

出版信息

Br J Ophthalmol. 2018 Oct;102(10):1351-1357. doi: 10.1136/bjophthalmol-2017-311377. Epub 2018 Jan 17.

BACKGROUND/AIMS: To investigate whether intravitreal injection of triamcinolone acetonide (IVTA) combined with vitrectomy prevents postoperative inflammation in patients with vitreous haemorrhage (VH) due to proliferative diabetic retinopathy (PDR).

METHODS

This prospective, multicentre, randomised study conducted at seven sites in Japan enrolled patients diagnosed as having VH following PDR. Patients underwent vitrectomy with (IVTA+VIT group) or without (VIT group) IVTA at the end of the surgery. Anterior flare intensity (AFI), central retinal thickness (CRT), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured before and at 3 days, 1 week, 1, 3 and 6 months after surgery and compared.

RESULTS

Number of patients who completed 6 months of follow-up was 40 and 41 in VIT group and IVTA+VIT group, respectively. AFI was significantly higher in the VIT group than in the IVTA+VIT group at 3 days (P=0.033), 1 week (P=0.019) and 1 month (P=0.037). There were no significant differences in CRT, BCVA and IOP between the groups through the observational periods. In the cases with macular oedema >350 µm of CRT at 3 days, CRT was significantly lower in the IVTA+VIT group than in the VIT group at 1 month (P=0.041).

CONCLUSIONS

IVTA combined with vitrectomy and cataract surgery contributed to inhibit the postoperative inflammation in patients with VH due to PDR. The effect of IVTA in the reduction of diabetic macular oedema may be limited to the early stage after surgery.

TRIAL REGISTRATION NUMBER

UMIN000020376, Post-results.

背景/目的：研究玻璃体积血（VH）继发于增生型糖尿病视网膜病变（PDR）患者中，曲安奈德（TA）玻璃体腔内注射（IVTA）联合玻璃体切除术是否能预防术后炎症。

方法

本研究在日本 7 个地点进行，是一项前瞻性、多中心、随机研究，纳入了诊断为 PDR 后继发 VH 的患者。患者接受玻璃体切除术，术中根据是否同时进行 IVTA 将患者分为 IVTA+VIT 组和 VIT 组。在术前、术后 3 天、1 周、1 个月、3 个月和 6 个月时，分别测量前房闪辉强度（AFI）、中心视网膜厚度（CRT）、最佳矫正视力（BCVA）和眼内压（IOP），并进行比较。

结果

分别有 40 例和 41 例患者完成了 6 个月的随访。术后 3 天（P=0.033）、1 周（P=0.019）和 1 个月（P=0.037）时，VIT 组的 AFI 明显高于 IVTA+VIT 组。在观察期间，两组间 CRT、BCVA 和 IOP 无显著差异。在术后 3 天 CRT＞350μm 的黄斑水肿患者中，IVTA+VIT 组术后 1 个月时 CRT 明显低于 VIT 组（P=0.041）。