【摘要】 目的:观察比较激光治疗与激光联合球后注射曲安奈德(triamcinolone acetonide, TA)治疗白内障术后慢性黄斑囊样水肿的临床疗效。方法:对37例37眼白内障术后发生慢性黄斑囊样水肿的患者17眼,球后注射曲安奈德联合激光光凝,20眼单纯光凝治疗,随访6mo,对比分析两组治疗前后视力、眼底荧光素血管造影的变化及并发症。结果:所有患者治疗1mo后视力多数有明显提高。治疗6mo后，联合治疗组视力提高>2行者11眼(65%),视力稳定及变化在1行之内者4眼(23%),视力下降>2行者2眼(12%);水肿减轻 14眼(82%),水肿未退 3眼(18%);单纯光凝组视力提高>2行者3眼(15%),视力稳定及变化在1行之内者11眼(55%),视力下降>2行者6眼(30%)。水肿减轻9眼(40%),水肿未退11眼(60%)。两组比较差异有统计学意义(P<0.05)。结论：激光联合球后注射曲安奈德较单纯激光治疗白内障术后黄斑囊样水肿疗效更好,且安全、方便。
【关键词】 白内障;黄斑囊样水肿;曲安奈德;光凝
Retrobulbar injection of triamcinolone acetonide combined with laser photocoagulation for chronic cystoid macular edema after cataract operation
Yan Qin, Ming Xu, JianJun Tao, Jin Yu Wang
Department of Ophthalmology, the Affiliated Hospital of Medical College of Yangzhou University,Changshu 215500, Jiangsu Provice, China
Abstract AIM: To investigate the effect of retrobulbar injection of triamcinolone acetonide(TA) combined with laser photocoagulation for chronic cystoid macular edema after cataract operation. METHODS: Thirtyseven patients 37 eyes with chronic cystoid macular edema after cataract operation were included. Seventeen eyes were treated with retrobulbar injection of TA combined with laser photocoagulation and twenty eyes only received laser photocoagulation. The followup time was 6 months. Visual acuity, fundus fluorescein angiography(FFA) and complications were observed and compared after treatment. RESULTS: All eyes had improved visual acuity after one month. At the end of the followup of 6 months, among the patients with retrobulbar injection of TA combined with laser photocoagulation, visual acuity was improved by 2 lines or more in 11 eyes (65%), improved within 1line or remained the same in 4 eyes (23%), decreased in 2 eyes (12%). Edema in 14 eyes (82%) was relieved after treatment. Among patients with laser photocoagulation, visual acuity was improved by 2 lines or more in 3 eyes (15%), improved within 1line or remained the same in 11 eyes (55%), edema in 9 eyes (40%) was relieved after treatment. The difference between the two groups was statistically significant (P<0.05). CONCLUSION: Retrobulbar injection of TA combined with laser photocoagulation for chronic cystoid macular edema after cataract operation is better than the operation only using laser photocoagulation
KEYWORDS: cataract; cystoid macular edema; triamcinolone acetonide; laser photocoagulation
0 引言
黄斑囊样水肿是白内障术后可能发生的一种并发症,严重影响患者中心视力。目前临床上常用方法包括局部或全身应用皮质类固醇，黄斑区格栅样光凝及手术治疗。近年来国内外有应用糖皮质激素曲安奈德(triamcinolone acetonide, TA)玻璃体内注射治疗各种原因引起的黄斑水肿的报道，并取得了较好的疗效，但眼内操作增加了眼内炎发生的风险(0.87%)[1],且在重复注药时风险更大,眼压升高的患者占52%,其他并发症如白内障亦有报道[2]。球后注射和玻璃体腔注射相比，在注射部位同样可以达到最大浓度、长时间持续的作用，且具有一次可用剂量大，并发症少，容易重复注射等优点[3]。200610/200910我们采用球后注射TA联合光凝治疗白内障术后慢性黄斑囊样水肿，观察治疗效果。
1 对象和方法
1.1 对象
本组共37例37眼，其中男20例20眼，女17例17眼，年龄45～76(平均65)岁，所有患者均行白内障超声乳化术;12眼为无晶状体眼，25眼为人工晶状体眼(19眼人工晶状体位于囊袋内，6眼人工晶状体位于睫状沟内)。无晶状体眼中8眼为外伤性白内障，患者晶状体后囊膜破裂，另4眼为白内障术中晶状体后囊膜破裂，均有玻璃体溢出。人工晶状体眼中有6眼白内障术中后囊膜有小的裂口，人工晶状体位于睫状沟内。其中老年性白内障12例，合并糖尿病患者8例，外伤性白内障10例，葡萄膜炎并发白内障4例，高度近视3例。黄斑囊样水肿持续时间为6～16(平均8)mo。所有病例治疗前行眼部详细检查，包括视力、眼压、前置镜检查眼底，眼底荧光血管造影(FFA)确诊。
1.2 方法
对37例37眼确诊的白内障术后黄斑囊样水肿的病例，随机分为两组，联合治疗组(球后注射曲安奈德联合黄斑格栅样光凝治疗)17例17眼，单纯光凝治疗组20例20眼。两组治疗前复方托品酰胺充分散瞳，采用氪黄激光行C形格栅样光凝，光斑直径100～150μm,曝光时间0.1～0.2s,激光功率100～200mW，产生Ⅰ～Ⅱ级光斑功率。联合治疗组黄斑格栅样光凝后患眼局部消毒后球后注射TA 20mg+20g/L利多卡因0.5mL,注射后局部按压3min，无出血及其它不适即可。以上操作均由同一熟练医师完成。疗效评价：两组治疗1,3,6mo后观察视力，眼压变化，前置镜检查眼底，眼底荧光血管造影(FFA)作为疗效评价指标。矫正视力提高2行或者2行以上者视力为增加，矫正视力波动在1行以内者为视力稳定，矫正视力下降2行或者2行以上者为视力下降。FFA检查中，水肿吸收50%以上为水肿减轻，水肿吸收不足50%为水肿未退。
统计学分析：采用SPSS 10.0统计软件包进行统计处理,治疗后组间视力的变化用χ2检验，P<0.05为差异有统计学意义。
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