曲安奈德辅助23G微创玻璃体切割治疗增生性糖尿病视网膜病变

摘要

目的 探讨23G微创玻璃体切割联合球内及后Tenon囊下应用曲安奈德治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy , PDR)的安全性和有效性. 方法 选择行23G玻璃体切割手术治疗的PDR患者86例(95只眼)进行回顾性研究.按治疗方式分为两组:联合药物治疗组40例(48眼),行标准三切口玻璃体切割术,术中球内注入曲安奈德8 mg行玻璃体染色并切割吸出,术毕后Tenon 囊下注射曲安奈德30 mg;单纯手术治疗组46例(47眼),单纯行玻璃体切割手术,未注射曲安奈德.比较两组术后矫正视力及眼压情况,黄斑中心凹厚度(central macular thickness , CMT)变化及前房炎症反应情况. 结果 所有患者随访6个月～2年,平均(1.31 ±0.63)年.组内比较,两组治疗后各时间点最佳矫正视力(BCVA)、 CMT值均较术前改善(P均＜0.05);组间比较,术后1月、3月、 6月联合药物治疗组BCVA、 CMT均优于单纯手术治疗组,差异均有统计学意义( P均＜0.05).两组患者眼压稳定,各时间点组内和组间比较均无统计学差异(P均＞0.05).术后联合药物治疗组前房炎症反应较单纯手术治疗组轻,差异具有统计学意义(P＜0.05).手术后3～5 d,前房反应逐渐消失,所有病例未发生术后感染. 结论 23G微创玻璃体切割联合曲安奈德术中玻璃体染色及术毕后Tenon囊下注射治疗增生性糖尿病视网膜病变有效安全,能减轻黄斑水肿,改善视功能.%Objective To study the safety and efficacy of 23-gauge mini-invasive vitrectomy combined with posterior sub-Tenoncapsule injection of triamcinolone acetonide in treating proliferative diabetic retinopathy (PDR). Methods A total of 86 PDR patients with 95 eyes underwent 23G vitrectomy were analyzed retro-spectively.According to therapeutic method , they were divided into two groups : 40 cases of 48 eyes were trea-ted by pars plana vitrectomy combined with injection of triamcinolone acetonide (TA) as the combined group , and 8 mg of TA was injected into the eyes for dying of vitreous during the operations and 30 mg of TA was injec-ted in the posterior sub-Tenoncapsule.46 cases of 47 eyes were performed direct vitrectomy as pure surgery group.The best corrected visual acuity (BCVA), intraocular pressure (IOP), changes of central macular thick-ness(CMT), and inflammation reaction of anterior chamber were compared between the two groups. Results All cases were followed up for 6 months to 2 years with an average of 1.31 ±0.63 years.The BCVA and CMT of the both groups were improved after treatment than those before the operation (P＜0.05).Both BCVA and CMT were better in the combined group than those in the pure surgery group at 1-, 3-and 6 months after the opera-tion, and the differences were statistical ( P＜0.05).The IOP was stable in both groups , and there was no statistic difference at different time points in both groups and between the two groups (P＞0.05).The inflam-mation reaction of anterior chamber in combined group was less than that in the pure surgery group (P＜0.05). Conclusion 23-gauge mini-invasive vitrectomy combined with posterior sub-Tenoncapsule injection of TA can reduce macular edema and improve visual acuity , and it is safe and effective for PDR.