Background The introvitreal injection of triamcinolone acetonide (TA) before vitrectomy for retinal with choroidal detachment (RD/CD) can alleviate inflammatory response,but it easily lead to complications under the low intraocular pressure.The study on the efficiency and safety of subtenon injection of TA for treatment of RD/CD is lack.Objective This study was to evaluate the efficiency and safety of subtenant injection of TA with vitrectomy for treatment of RD/CD.Methods A retrospective study was adopted.The data of 22 eyes of 22patients who received subtenon injection of TA with vitrectomy for RD/CD were collected and analyzed in Affiliated Eye Hospital of Wenzhou Medical University from May 2010 to June 2014.TA of 40 mg in 0.4 ml was administered subtenantly 5 days before RD repair surgery.After initiating the treatment,the therapeutic effects on uvitis were analyzed.Intraocular pressure was monitored and CD height and range were determined by B type ultrasonography before injection and 5 days after injection respectively.In addition,blood glucose and blood pressure of the patients were evaluated.Results Ocular inflammation alleviated to some degree after TA injection in all 22 eyes.The mean intraocular pressure was (5.4±2.9) mmHg (1 mmHg =0.133 kPa) in pre-injection and (8.2±4.3) mmHg in postinjection,showing a significant difference between them (t =3.430,P ＜ 0.01).The mean maximum CD height was 5.2 (3.1,6.6)mm in pre-injection and 0.9 (0,3.8)mm in post-injection,with a significant difference between the before and after injection (Z=-4.198,P＜0.01).The mean CD range was 12 (10,12) clock before injection and 3(0,6) clock after injection,and no significant difference was found between before and after injection (all at P＞0.05) (Z=-4.124,P＜0.01).There were no statistically significant difference in the changes of blood glucose and blood pressure between before and after injection.The LogMAR visual acuities were 2.14±0.46,1.29±0.57 and 1.17±0.55 before injection and 1 month,3 months after injection,respectively,with a siginificant difference among them (F =22.060,P＜0.001).The retinal reattachment rate was 95.5 ％.Conclusions Subtenon injection of TA seems to be a good option for perisurgical management of RD/CD patients,which can alleviate uvitis,increase intraocular pressure,reduce CD height and CD range.%背景 曲安奈德具有抗光作用,脉络膜脱离型视网膜脱离(RD/CD)术前玻璃体腔内注射TA可减轻炎症反应,改善手术效果,但由于术前眼压低,玻璃体腔注射易引起并发症.关于后Tenon囊下注射TA在RD/CD中的有效性和安全性尚未见报道. 目的 探讨后Tenon囊下注射TA治疗RD/CD的疗效及安全性.方法 采用回顾性研究方法,收集于2010年5月至2014年6月在温州医科大学附属眼视光医院首诊为RD/CD且接受手术的患者22例22眼的病历资料,患眼均于玻璃体切割术前5d行后Tenon囊下注射TA混悬液40 mg(0.4 ml),注药后观察葡萄膜的炎性反应.使用Goldmann眼压计和B型超声仪观察注药前及注药后5d患眼眼压、脉络膜脱离高度及脱离范围的变化,同时监测血压及血糖的变化,并于注药5d后行玻璃体切割术,所有患者术后随访3个月以上. 结果 行TA的后Tenon囊下注射的22眼葡萄膜炎症状均不同程度减轻;注药前患眼平均眼压为(5.4--.2.9) mmHg(1 mmHg=0.133 kPa),注射TA后5d患眼平均眼压为(8.2±4.3) mmHg,眼压上升2.8 mmHg,差异有统计学意义(t=3.430,P＜0.01).注药前患眼平均脉络膜脱离高度为5.2(3.1,6.6)mm,注药后5d平均脉络膜脱离高度为0.9(0,3.8)mm,脉络膜脱离高度显著降低,差异有统计学意义(Z=-4.198,P＜0.01).注药前患眼平均脉络膜脱离范围为12(10,12)个点位,注药后5d平均脉络膜脱离范围为3(0,6)个点位,脱离范围显著下降,差异有统计学意义(Z=-4.124,P＜0.01).患者注药前后血糖、血压变化的差异均无统计学意义(均P＞0.05).术眼术前、术后1个月和3个月LogMAR视力分别为2.14±0.46、1.29±0.57和1.17±0.55,术后视力较术前明显好转,总体比较差异有统计学意义(F=22.060,P＜0.001).视网膜复位率为95.5％.7眼术后出现高眼压,其中5眼使用局部降眼压药物治疗后恢复,2眼药物取出后眼压恢复正常. 结论 RD/CD术前行TA后Tenon囊下注射能减轻术眼葡萄膜炎反应,升高眼压及降低脉络膜脱离,对血糖、血压影响小.
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