Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
Department of Ophthalmology, Kragujevac Clinical Center, Kragujevac, Serbia.
Acta Clin Croat. 2022 Dec;61(4):620-628. doi: 10.20471/acc.2022.61.04.08.
Diabetic macular edema is the most common cause of vision loss in patients affected by diabetes mellitus. For eyes with persistent retinal thickening despite anti-VEGF therapy, treatment with intravitreal triamcinolone may be considered, especially in pseudophakic eyes. The aim of this study was to examine aqueous humor nitric oxide concentration changes in pseudophakic eyes with persistent diffuse diabetic macular edema after intravitreal injection of triamcinolone acetonide, as well as the potential impact of these changes on the intraocular pressure values. In 10 pseudophakic eyes with persistent diffuse diabetic macular edema, paracentesis of anterior chamber with aspiration of aqueous humor and nitric oxide concentration measurements were done on the day of the intravitreal application of 20 mg triamcinolone acetonide, and after 1, 3, 6 and 9 months. Also, we were recording intraocular pressure values before the intravitreal triamcinolone acetonide injection and during the next 9 months. One month after the intravitreal triamcinolone acetonide injection, we noticed a decrease of nitric oxide concentration (45.37±5.55 µmol/L) by 31.79% compared to the initial values (66.52±7.66 µmol/L). After that, nitric oxide concentrations began to rise slightly, and at the end of the ninth month the mean nitric oxide concentration was similar to that recorded at the beginning of the study. Intraocular pressure values had increasing trend one month after the intravitreal triamcinolone acetonide injection (23.70±4.08 mm Hg) compared to the initial values (16.21±1.55 mm Hg), but after nine months these values returned to normal levels. Decreased concentration of nitric oxide could be one of the reasons for increased intraocular pressure after intravitreal application of triamcinolone acetonide in the treatment of diffuse diabetic macular edema.
糖尿病性黄斑水肿是糖尿病患者视力丧失的最常见原因。对于尽管接受抗 VEGF 治疗但仍存在视网膜持续性增厚的眼睛，可以考虑使用玻璃体内曲安奈德治疗，尤其是在人工晶状体眼。本研究旨在研究玻璃体内曲安奈德注射治疗后持续性弥漫性糖尿病性黄斑水肿的人工晶状体眼房水中一氧化氮浓度的变化，并研究这些变化对眼内压值的潜在影响。在 10 例持续性弥漫性糖尿病性黄斑水肿的人工晶状体眼，在玻璃体内应用 20mg 曲安奈德的当天，以及在 1、3、6 和 9 个月后，行前房穿刺抽吸房水并测量房水中的一氧化氮浓度。同时，我们在玻璃体内曲安奈德注射前及随后的 9 个月内记录眼内压值。玻璃体内曲安奈德注射后 1 个月，我们发现与初始值（66.52±7.66µmol/L）相比，一氧化氮浓度（45.37±5.55µmol/L）下降了 31.79%。此后，一氧化氮浓度开始略有上升，在第 9 个月末，平均一氧化氮浓度与研究开始时相似。与初始值（16.21±1.55mm Hg）相比，玻璃体内曲安奈德注射后 1 个月，眼内压值呈升高趋势（23.70±4.08mm Hg），但 9 个月后，这些值恢复到正常水平。玻璃体内应用曲安奈德治疗弥漫性糖尿病性黄斑水肿后，眼内压升高可能是一氧化氮浓度降低的原因之一。
