结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿的临床观察

摘要

目的 观察结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿(UME)的疗效及安全性.方法 回顾性系列病例研究.收集2009年7月至2014年6月于北京协和医院眼科门诊确诊为UME患者的临床资料,将接受结膜下注射曲安奈德治疗并规律随诊至少6个月的32例(37只眼)患者纳入观察.治疗前后黄斑中心凹视网膜厚度(CMT)、最佳矫正视力(BCVA)及治疗后眼压升高为主要观察指标.采用配对t检验进行统计学分析.结果 37只眼首次结膜下注射曲安奈德1个月后,24只眼(64.9％)黄斑水肿明显好转,20只眼(54.1％)视力提高.平均CMT[(392.4±232.3)μm]较注射前[(498.9±211.9)μm]降低(t=-4.070,P＜0.01),平均BCVA(log MAR,0.33±0.30)较注射前(logMAR,0.45±0.29)提高(t=-4.835,P＜0.01),差异有统计学意义.3个月内,23只眼因明显好转未加用其他药物治疗,注射后3个月CMT及BCVA较注射后1个月改变无统计学意义.6个月内,23只眼中7只眼(30.4％)复发,再次注射有效.首次注射后9只眼眼压升高,再次注射后3只眼眼压升高,均可用局部降眼压药物或曲安奈德取出术控制.结论 结膜下注射曲安奈德可作为葡萄膜炎继发黄斑水肿的治疗方法之一,可明显减轻黄斑水肿,改善视力.其主要副作用是引起眼压升高,但可以通过局部使用降眼压药物或行曲安奈德取出术加以控制.%Objective To observe the efficacy and safety of subconjunctival triamcinolone acetonide injections in the treatment of uveitic macular edema (UME).Methods A retrospective case series study.The clinical data of uveitis patients with macular edema were collected and analyzed at Peking Union Medical College Hospital from July 2009 to June 2014 with a minimum follow-up period of 6 months.The main outcome was central macular thickness (CMT) measured by optical coherence tomography at the 1st and the 3rd month after injection.The secondary outcomes included best corrected visual acuity (BCVA) at the 1st and the 3rd month, recurrence rate and intraocular pressure (IOP) within 6 months after injection.Results Thirty two patients (37 eyes) were included in the study.At the 1st month after the first injection, 24 of the 37 eyes (64.9％) showed an obvious reduction of CMT (at least 20％), among them 15 eyes (40.5％) showed a total resolution.The mean C MT decreased from (498.9±211.9)μm at baseline to (392.4±232.3) μm (t=-4.070, P＜0.01).The BCVA improved in 20 eyes (54.1％) and 15 eyes (40.5％) gained more than 0.2 log MAR unit.The mean BCVA increased from logMAR, 0.45±0.29 at baseline to logMAR, 0.33±0.30 (t=-4.835, P＜0.01).No statistically significant difference was found in mean CMT or BCVA in 23 eyes between the 1st and the 3rd month after injection.These eyes didn't receive any additional medications for improvement of the condition.Seven eyes (30.4％, 7/23) got a second injection because of relapse within 6 months after the first injection and the efficacy was good.The elevation of IOP over 21 mmHg(1 mmHg=0.133 kPa) were observed in 9 eyes and 3 eyes after the first and the second injection respectively.All of them were well controlled by either topical IOP lowering drugs or removal of the subconjunctival TA deposition.Conclusion Subconjunctival injection of triamcinolone acetonide is an effective and safe method for uveitic macular edema.