曲安奈德在合并NPDR的白内障手术中的应用

目的：对合并NPDR的白内障患者，在行白内障超声乳化手术中行后筋膜囊下注射TA，通过频域相干光断层深度增强成像(EDI SD-OCT)检查对黄斑区术前术后的分析比较，研究曲安奈德对黄斑水肿的干预及预防作用。

方法：在一项前瞻性随机临床试验中，选取我院合并NPDR的白内障患者，随机分成两组，试验组在实施白内障超声乳化手术时后筋膜囊下注射TA 40mg，对照组仅实施白内障超声乳化吸除手术。术前、术后观察BCVA、IOP、CMT、黄斑中心凹下脉络膜厚度(SFCT)的变化。

结果：两组术前和术后的BCVA均有差异(P<0.05)； 术后1wk时，对照组的SFCT比试验组增厚(t=2.165，P<0.05)； 术后2wk时，两组间CMT、SFCT均有差异(P<0.05)； 术后1mo时，两组间BCVA、CMT均有差异(P<0.05)。两组术前和术后的IOP无差异(P>0.05)。对于术后发生DME，试验组、对照组的发生率分别为0、11%。

结论：NPDR患者在行白内障超声乳化手术中行后筋膜囊下注射TA，可能对DME的发生有积极的预防作用。

Application of Triamcinolone acetonide in cataract surgery with NPDR

AIM: To observe the changes of retina and choroid in macular region using EDI SD-OCT before and after phacoemulsification, and study the intervention and prevention effect of triamcinolone acetonide(TA)on macular edema.

METHODS: In a prospective randomized clinical trial, selected the cataract patients with NPDR in our hospital. They were randomly divided into two groups. The experimental group(group 1)received Tenon''s injection of TA 40mg during phacoemulsification, while the control group(group 2)only received phacoemulsification. The changes of best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular retinal thickness(CMT), subfoveal choroidal thickness(SFCT)before and after surgery were observed.

RESULTS: There were significant differences in BCVA between the two groups before and after operation(P<0.05); at 1wk after operation, the SFCT of the control group was thicker than that of the experimental group(t=2.165, P<0.05); at 2wk after operation, there were significant differences between the CMT and SFCT groups(P<0.05). There were significant differences in BCVA and CMT between the two groups(P<0.05), and no significant difference in IOP(P>0.05).The incidence of diabetic macular edema(DME)after surgery was 0 in group 1 and 11% in group 2.

CONCLUSION: Posterior subfascial injection of TA in NPDR patients during phacoemulsification may have a positive preventive effect on the occurrence of DME.