曲安奈德玻璃体腔注射治疗糖尿病性黄斑水肿致眼压升高的临床研究

摘要

Objective:To evaluate the changes in intraocular pressure ( IOP ) after intravitreal injection of triamcinolone acetonide for the management of diabetic macular edema( DME) . Methods:The study design is a prospective, interventional, dose-response study. 83 eyes with DME were included,Randomly divided into two groups,eyes of one group underwent intravitreal injection of 4 mg triamcinolone acetonide(42 eyes),and eyes of another group underwent intravitreal injection of 8 mg triamcinolone acetonide ( 41 eyes ); The patients were followed up for 6 months after injection;Intraocular pressure was measuremented and controled. Results:After injection. Significant IOP rise was observed in both groups with an incidence of 76. 2%and 73. 2%in groups A and B,respectively. IOP-lowering drugs were used to control IOP,satisfactory effect was achieved. however,six eyes needed glaucoma filtration surgery after intractable glaucoma with failure of medical treatme-nt. Conclusion:Although intravitreal injection of triamcinolone acetonide is very effective in managing DME and with lower cost than other modalities,the rise in IOP and the burden of glaucoma are major concerns. High corticosteroid responder is an individualized reaction irrespective of the intravitreal triamcinolone acetonide dose used.%目的：：观察玻璃体腔内注射曲安奈德( TA)治疗糖尿病性黄斑水肿( DME)后眼压( IOP)升高及控制情况。方法：本研究为前瞻性、介入性、剂量-疗效研究。62例83眼DME病人,随机分为两组,一组病人行玻璃体腔内注射曲安奈德4mg(A组,42眼),另一组玻璃体腔注射曲安奈德8mg(B组,41眼)。注射术后随访6mo；并于1mo,3mo,6mo进行眼压测量及控制。结果：曲安奈德玻璃体腔注射后,两组病人术后眼压升高发生率分别为76.2%、73.2%。降眼压药物用于控制眼压大部分病人可达到满意效果,6例术后青光眼需滤过手术治疗。结论：尽管玻璃体腔内注射曲安奈德是非常有效的DME治疗手段,但高眼压和致青光眼是其主要并发症。但我们推测高皮质醇应答是一种个性化反应,与曲安奈德玻璃体腔注射剂量无关。