玻璃体腔内注射曲安奈德联合激光治疗视网膜静脉阻塞引起黄斑水肿

目的了解玻璃体腔内注射曲安奈德（TA）联合视网膜激光光凝治疗视网膜静脉阻塞（RVO）引起的黄斑水肿的有效性和安全性。方法经散瞳间接眼底镜检查、光学相干断层扫描（OCT）及眼底血管荧光造影（FFA）检查证实为视网膜静脉阻塞所致黄斑水肿病人35例35只眼（其中人工晶体眼9例9只眼）,玻璃体腔内注射40 g/L的TA 0.1 mL及视网膜激光光凝治疗,随访3～10个月,观察视力、眼压、晶状体、炎症反应、眼底情况,OCT检查视网膜厚度改变,FFA检查黄斑区毛细血管渗漏情况。结果治疗1、2个月时,所有患眼视力提高,在FFA指导下分次行视网膜激光光凝。最终随诊视力0.3～0.4占48.6%,视力≥0.5占28.5%,与治疗前比较97%患眼视力有不同程度提高,3%患眼视力无改善,无视力下降。3只眼在注药后1～3周眼压先后出现不同程度升高,达到3.1～4.3 kPa,2只眼在注药后第2、3天时出现下方局限性视网膜下小片状出血;3只眼注药后第3天出现前房炎症细胞,积脓1 mm,3只眼均为人工晶体眼,1周内炎症细胞消失。所有病人晶状体未受影响。结论玻璃体腔内注射TA联合视网膜激光光凝可以有效治疗RVO引起的黄斑水肿,提高视力,部分病人可出现高眼压、黄斑水肿复发等并发症。

INTRAVITREOUS INJECTION OF TRIAMCINOLONE ACETONIDE COMBINED WITH LASER THERAPY FOR MACULAR EDEMA CAUSED BY RETINAL VEIN OCCLUSION

Objective To investigate the efficacy and safety of combination of intravitreous injection of triamcinolone acetonide （TA） and laser therapy for macular edema due to retinal vein occlusion. Methods Thirty-five eyes in 35 patients, in which nine eyes in nine patients were pseudophakia, with the disease confirmed by ophthalmoscopy, optic coherent tomography and fundus fluorescein angiography were given intravitreous injection of 0.1 mL TA （40 g/L） and retinal photocoagulation. The vision, intraocular tension, lens, inflammatory reaction, fundus, thickness of retina, and vascular leakage were observed during 3--10 month follow-up. Results One and two months after therapy, the vision of all the patients improved, 48.6% with a vision of 0.3-0.4, and 28.5% with a vision of ≥0.5. Compared with before treatment, the vision of 34 （97%） eyes improved and one （3%） eye unimproved. Increased ocular pressure was noted in three eyes, subretinal hemorrhage in two eyes, and inflammatory cells in three eyes with pseudophakia, all occurred within 1--3 weeks after the injection. All the lens were not affected. Conclusion Combo therapy of intravitreous injection of TA plus retinal photocoagulation can effectively treat macular edema caused by retinal vein occlusion and improve patients＇ vision, but recurrence or increase of intraocular pressure may occur in some of them.