玻璃体切除联合半量曲安奈德玻璃体内注射治疗增生性糖尿病视网膜病变

摘要

目的 探讨玻璃体切除术联合半量曲安奈德(triamcinolone acetonide)玻璃体内注射治疗增生性糖尿病视网膜病变疗效和安全性.方法 回顾性分析增生性糖尿病视网膜病变32例(39眼)经玻璃体切除术联合半量曲安奈德(2 mg/0.05 ml)玻璃体内注射的临床资料,术中根据病情进行剥膜、眼内激光、巩膜外冷凝、硅油或C3F8填充.术后观察视力、眼压、前房炎症反应、晶状体浑浊、有无玻璃体视网膜出血及视网膜脱离情况.结果 随访3 ～18月,平均(7.81 ±4.52)月,36眼(92.31％)术后视力有不同程度的提高,术后视力与术前相比差异有统计学意义(z=-5.539,P=3.03×10-8).术后3个月眼压与术前眼压差异无统计学意义(t=-0.204,P=0.84).术后2周内发生一过性高眼压8眼(20.51％),通过降眼压药物治疗,眼压恢复正常.前房有轻度炎症反应,白内障8眼(20.51％),视网膜脱离2眼(5.13％).结论 玻璃体切除术联合半量曲安奈德玻璃体内注射是治疗增生性糖尿病视网膜病变安全、有效的方法,能控制眼内炎症,改善视力,严重并发症较少发生.%Objective To investigate the efficacy and safety of pars plana vitrectomy (PPV) combined with intraviteal injection of half-dose triamcinolone acetonide (TA) for proliferative diabetic retinopathy (PDR).Methods Thirty-nine eyes of 32 patients with PDR accepted PPV combined with intraviteal injection of half-dose TA (2 mg/0.05 ml).And membrane peeling,retinal photocoagulation,scleral cryocoagulation,silicone oil or C3F8 gas tamponade were applied according to particular situation respectively.The visual acuity,intraocular pressure (IOP),inflammatory reaction of anterior chamber,lens opacification,vitreoretinal hemorrhage and detachment of retina were observed and analyzed after the procedure.Results Postoperative following up was 3 ～ 18 months,with average (7.81 ±4.52) months.The visual acuity was improved in 36 eyes (92.31％),and the difference was statistically significant between the preoperative one and the postoperative one (Z =-5.539,P =3.03 × 10-8).The difference between the preoperative IOP and the postoperative lOP 3rd month postoperatively was not statistically significant (t =-0.204,P =0.84).Transient postoperative elevated IOP occurred in 8 eyes (20.51％) in two weeks after surgery.All cases had mild inflammatory reaction of anterior chamber.Cataract appeared in 8 eyes (20.51％).And retinal detachment occurred in 2 eyes (5.13％).Conclusion PPV combined with intraviteal injection of half-dose TA is safe and effective for the treatment of PDR.It could control inflammation and improve visual acuity with few serious complications.