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目的观察玻璃体内注射曲安奈德(TA)治疗视网膜中央静脉阻塞(CRVO)引起黄斑囊样水肿(CME)的疗效和安全性。方法14例CRVO所致CME患者14只眼玻璃体内注入40mg/ml的TA0.1ml。治疗前后均进行最佳矫正视力、眼压、裂隙灯显微镜、荧光素眼底血管造影(FFA)和光相干断层扫描(OCT)检查。随诊观察10.0～22.4个月,平均随诊观察时间为15.9个月。结果治疗前平均视力为0.1。治疗1、3个月时,100%的患眼视力提高,其中,视力≥0.2者分别为71.4%和63.6%,视力≥0.5者分别为42.9%和27.3%。此后,部分患者视力下降,最终随诊时视力≥0.2者占28.6%,≥0.5者占7.1%,与治疗前比较,71.4%的患眼视力有不同程度的提高,28.6%的患眼视力下降。治疗后1个月时,OCT检查显示黄斑水肿完全消退10只眼,占71.43%,水肿明显减轻4只眼,占28.57%。最终随诊时,OCT检查显示黄斑水肿完全消退4只眼,减轻9只眼,加重1只眼。7只眼在注射药物后1周～6个月期间先后出现不同程度的高眼压,眼压达到22.3～40.1mmHg(1mmHg=0.133kPa),在最终随诊时7只眼出现了晶状体后囊膜下混浊的并发性白内障。结论玻璃体内注射TA短期内能有效改善黄斑水肿和明显提高视力,部分治疗眼出现高眼压;远期观察黄斑水肿的复发率和晶状体后囊膜下混浊的发生率均较高。
Objective To observe the efficacy and safety of intravitreal injection of triamcinolone acetonide (TA) in treatment of central retinal vein occlusion (CRVO) caused by macular cystoid edema (CME). Methods Fourteen 14 eyes of CME induced by CRVO were intravitreally injected with 40 mg / ml TA 0.1 ml. The best corrected visual acuity, intraocular pressure, slit lamp microscopy, fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed before and after treatment. Follow-up observation of 10.0 ~ 22.4 months, the average follow-up observation time was 15.9 months. Results The average visual acuity before treatment was 0.1. At 1 month and 3 months after treatment, 100% of patients had visual acuity improved, of which 71.4% and 63.6% had visual acuity ≥0.2, and those with visual acuity ≥0.5 were 42.9% and 27.3% respectively. Since then, some patients with decreased visual acuity, the final follow-up visual acuity ≥ 0.2 accounted for 28.6%, ≥ 0.5 accounted for 7.1%, compared with pre-treatment, 71.4% of patients with varying degrees of visual acuity increased, 28.6% . At 1 month after treatment, OCT examination showed macular edema completely subsided in 10 eyes, accounting for 71.43%, edema was significantly reduced in 4 eyes, accounting for 28.57%. At the final follow-up, OCT showed macular edema completely subsided in 4 eyes, relieved in 9 eyes and exacerbated in 1 eye. Seven eyes showed varying degrees of intraocular hypertension from 1 week to 6 months after injection, with intraocular pressure reaching 22.3-40.1 mmHg (1 mmHg = 0.133 kPa). At the final follow-up, there were 7 cases of posterior capsule Subconjunctival concomitant cataract. Conclusion Intravitreal injection of TA in short term can effectively improve macular edema and improve visual acuity, and ocular hypertension appears in some eyes. The recurrence rate of macular edema and the incidence of posterior subcapsular opacity are higher in long term.