目的 探讨玻璃体注射低剂量曲安奈德(TA)联合光凝治疗弥漫性糖尿病黄斑水肿的短期疗效及安全性.方法 玻璃体单次注射TA 2 mg/0.1 mL治疗非增生性弥漫性DME 21例(25只眼).基线检查包括最佳矫正视力、眼压、荧光素眼底血管造影(FFA)和相干光断层扫描(OCT)测量黄斑中心厚度.术后1 d、1周、1个月、3个月、6个月检查矫正视力、眼压、黄斑中心厚度及并发症的发生情况.结果 治疗后1周与术前相比,患者视力有显著提高(P=0.003);治疗后1个月与治疗后1周相比,视力无显著差异(P=0.392);治疗后3个月与治疗后1个月相比,视力没有显著差异(P=0.763);治疗后6个月与术前相比,视力没有显著差异(P=0.169),与治疗后3个月相比,视力显著下降(P=0.004).治疗后1 d黄斑区神经上皮层厚度与术前相比,显著降低(P=0.000);治疗后1个月与治疗后1周相比,显著降低(P=0.000);治疗后3个月与治疗后1个月相比,没有显著差异(P=0.392);治疗后6个月与术前相比,黄斑区神经上皮层厚度显著降低(P=0.000),与治疗后3个月相比,显著升高(P=0.004).治疗后6个月随访眼压平均值均处于正常水平,所有患者均未出现出现无菌性眼炎、感染性眼内炎、玻璃体出血及视网膜脱离等并发症.1例(1只眼)发生白内障进展.结论 低剂量TA玻璃、体注射治疗DME并发症少,是短期控制黄斑水肿、提高视力的一个比较有效安全的治疗方法.%Objective To evaluate the short time clinical therapeutic efficacy and safety of 2 mg dose intravitreal triamcinolone acetonide( IVTA ) for diffused diabetic macular edema( DME ). Methods Twenty-five eyes with nonprolifera-tive diffused DME received single injection of 2 mg/0. 1ml TA into vitreous. The baseline examination included best-correct visual acuity(BCVA ), intraocular pressure(IOP ) , fundus fluorescein angiography( FFA ) and optical coherence tomography} OCT Jmeasured retinal thickness. BCVA, thickness of the neurosensory retina,IOP and adverse reaction were measured after the treatment. Results The BCVA at one week follow-up was significantly better than that at baseline( P = 0. 003 ). The one month follow-up BCVA had no significant difference with that at after one week( P = 0. 392 ). The three months follow-up BCVA had no significant difference with that at after one month{ P =0.763 ). After six months follow-up, the BCVA had no significant difference compared to that at the baseline! P = 0. 169 ), declined significantly compared to that at the three months( P =0. 004 ). The central macular thickness at one day after injection reduced significantly compared to the baseline(P =0. 000 ) ,and it at one month follow-up significantly reduced compared to that at one week( P = 0. 000 ). At the three months,the central macular thickness had no significant diffence compare to that at after one month! P =0.392 ). At six months follow-up, the central macular thickness reduced significantly compared to the baseline( P = 0. 000 ),increased significantly compared to that at three months! P =0.004 ). At the six months follow-up,the mean IOP was normal. All patients had no complications such as aseptic inflammation, infectious endophthalmitis, vitreous hemorrhage and retinal detachment, except one case of cataract. Conclusion Low dose IVTA is a relatively safe and effective treatment method for the short-term control of DME with less complications.
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