Effect of Intravitreal Injection of Triamcinolone Acetonide Combined with Laser Photocoagulation in Treatment of 32 Cases of Diabetic Macular Edema
吕旭东, 龚兰兰, 柴基桥
湖北省咸宁市中心医院、湖北科技学院附属第一医院眼科,咸宁 437100
LYU Xudong,, GONG Lanlan, CHAI Jiqiao
Department of Ophthalmology, Xianning Central Hospital, Hubei Province, the First Affiliated Hospital, Hubei University of Science and Technology, Xianning 437100, China
Objective To investigate the clinical efficacy of vitreous cavity injection of triamcinolone acetonide (IVTA) combined with laser photocoagulation in the treatment of diabetic macular edema (DME). Methods 87 eyes from 64 patients with DME were enrolled in this study. They were divided into two groups by random number table. The treatment group consisted of 32 cases (46 eyes), and the control group consisted of 32 cases (41 eyes). The control group was treated with laser photocoagulation, and the treatment group was treated with laser photocoagulation and IVTA treatment. Then the therapeutic effects were compared between the two groups Results The effective rate of the treatment group and the control group was 95.65% and 80.49%, respectively (P<0.05), and the efficacy of the treatment group stage II DME patients was better than that of the control group stage II DME patients. There was no significant difference in efficiency between the two groups in stage III and IV (P>0.05). The retinal thickness and average retinal nerve fiber layer thickness of the macular area were significantly decreased in the two groups at 1, 3 and 6 months after operation. The thickness of the retina and average retinal nerve fiber layer in the macular area at 1, 3 and 6 months after operation were significantly lower than the control group (P<0.05). Conclusion Laser photocoagulation combined with IVTA is more effective than single laser photocoagulation in the treatment of DME, especially for early DME patients, the treatment effect is more obvious and worthy of clinical application.
目的:观察超声乳化联合曲安奈德玻璃体腔内注射(IVTA)对白内障合并糖尿病黄斑水肿患者的临床疗效。方法:将白内障合并糖尿病黄斑水肿患者44例52眼随机分为两组:对照组行白内障超声乳化联合人工晶状体植入手术;IVTA组在对照组手术的基础上,联合IVTA治疗。所有患眼均接受裂隙灯显微镜、光相干断层(OCT)、最佳矫正视力(BCVA)及间接检眼镜检查。比较各组治疗前后平均最小分辨角对数(Log MAR BCVA)及黄斑中心凹厚度(CMT)变化。并对手术治疗6mo后平均Log MAR BCVA和各因素进行相关性分析。采用多因素线性回归分析法分析术后6mo视力恢复的影响因素。结果:各组治疗1、3、6mo后Log MAR BCVA均明显改善,差异具有统计学意义(F=3.351、4.588,P=0.022、0.005),但两组间无统计学差异(P0.05)。手术后1、3mo后,IVTA组CMT显著低于对照组(t=3.402、2.083,P=0.001、0.042),手术后6mo时无明显差别。手术后6mo平均Log MAR BCVA与ELM(中心凹外界膜)状态负相关(r=-0.611,P=0.006)。多因素线性回归分析结果显示,手术后6mo视力恢复与中心凹外界膜ELM状态(B=0.333,P=0.030)和糖尿病病程(B=-0.307,P=0.005)具有相关性。结论:超声乳化手术联合IVTA治疗白内障合并糖尿病黄斑水肿,可在短期内减轻黄斑水肿,改善视力。IVTA对改善黄斑水肿的作用更为明显。
MARTIDISA,DUKER JS,GREENBERG PB,et al.Intravitreal triamcinolone for refractory diabetic macular edema[J].,2006,113(9):1533-1538.
To report 2-year safety and efficacy outcomes from a trial of intravitreal triamcinolone acetonide (TA) injections (4 mg) in eyes with diabetic macular edema and impaired vision that persisted or recurred after laser treatment. Prospective, double-masked, placebo-controlled, randomized clinical trial. Sixty-nine eyes of 43 patients were entered into the study, with 34 eyes randomized to receive active treatment and 35 placebo. Two-year data were available for 60 of 69 (87%) eyes of 35 of 41 (85%) patients; 9 eyes of 6 patients were lost to follow-up, of which 6 received a placebo and 3 received intravitreal TA. Triamcinolone acetonide (0.1 ml) was injected through the pars plana using a 27-gauge needle. Eyes randomized to placebo received a subconjunctival injection of saline. Improvement of best-corrected logarithm of the minimum angle of resolution visual acuity (VA) by ≥5 letters after 2 years and incidence of moderate or severe adverse events. Improvement of ≥5 letters’ best-corrected VA was found in 19 of 34 (56%) eyes treated with intravitreal TA, compared with 9 of 35 (26%) eyes treated with the placebo ( z generalized estimating equation = 2.73, P = 0.006). The mean improvement in VA was 5.7 letters (95% confidence interval, 1.4–9.9) more in the intravitreal TA–treated eyes than in those treated with the placebo. An increase of intraocular pressure (IOP) of ≥5 mmHg was observed in 23 of 34 (68%) treated versus 3 of 30 (10%) untreated eyes ( P<0.0001). Glaucoma medication was required in 15 of 34 (44%) treated versus 1 of 30 (3%) untreated eyes ( P = 0.0002). Cataract surgery was performed in 15 of 28 (54%) treated versus 0 of 21 (0%) untreated eyes ( P<0.0001). Two eyes in the intravitreal TA–treated group required trabeculectomy. There was one case of infectious endophthalmitis in the treatment group. Intravitreal TA improves vision and reduces macular thickness in eyes with refractory diabetic macular edema. This beneficial effect persists for up to 2 years with repeated treatment. Progression of cataract and elevation of IOP commonly occur but appear manageable. Spontaneous improvement over years can still occur in eyes that are apparently severely affected by diabetic macular edema.
JONAS JB,KREISSIGI,DEGENRINGR.Intraocular pres-sure after intravitreal injection of triamcinolone acetonide[J].,2003,87(1):24-27.
AIM: To investigate the intraocular pressure (IOP) response after intravitreal injections of triamcinolone acetonide as treatment of intraocular neovascular or oedematous diseases. METHODS: The prospective consecutive non-comparative interventional case series study included 71 patients (75 eyes) with progressive exudative age related macular degeneration (n = 64 eyes) or diffuse diabetic macular oedema (n = 11 eyes), who received an intravitreal injection of 25 mg triamcinolone acetonide. Mean follow up time was 6.86 (SD 2.52) months (range 3.1-14.47 months). RESULTS: IOP increased significantly (p<0.001) from 15.43 (3.26) mm Hg preoperatively to a mean maximum of 23.38 (8.37) mm Hg (range 13-64 mm Hg) postoperatively. An IOP rise to values higher than 21 mm Hg was observed in 39 (52%) eyes. Elevation of IOP occurred about 2 months after the injection. Preoperative predictive factor for the rise in IOP was younger age (p=0.013). It was statistically independent of refractive error, presence of diabetes mellitus, and indication for the injection. In all but one eye, IOP could be lowered to the normal range with topical medication, without development of glaucomatous optic nerve head changes. In the eyes with an elevation of IOP, IOP normalised about 6 months after the injection, without further medication. Eyes undergoing repeatedly intravitreal injections of triamcinolone acetonide showed only an elevation of IOP, if after the first injection a rise of IOP had occurred. CONCLUSIONS: After intravitreal injections of 25 mg of triamcinolone acetonide, an IOP elevation can develop in about 50% of eyes, starting about 1-2 months after the injection. In the vast majority, IOP can be normalised by topical medication, and returns to normal values without further medication about 6 months after the injection.
YAMASHITAT,UEMURAA,KITAH,et al.Intraocular pressure after intravitreal injection of triamcinolone acetonide following vitrectomy for macular edema[J].,2007,16(2):220-224.
Abstract PURPOSE: To evaluate long-term intraocular pressure (IOP) response after intravitreal injections of different doses of triamcinolone acetonide (TA) upon completion of pars plana vitrectomy (PPV) for macular edema secondary to diabetic retinopathy or retinal vein occlusion. PATIENTS AND METHODS: Retrospective, consecutive, comparative, interventional case series. Twenty-seven eyes of 25 consecutive patients with macular edema associated with diabetic retinopathy (n=18) or retinal vein occlusion (n=9), who underwent PPV for the treatment of macular edema between January 2003 and December 2003, were included. Upon completion of vitrectomy, different doses of TA were injected into the vitreous cavity: 14 eyes with 5 mg of TA (group 1) and 13 eyes with 10 mg of TA (group 2). The main outcome measure was IOP. RESULTS: All patients were followed up for at least 12 months. Preoperative IOP was 12.6+/-2.6 mm Hg (mean+/-standard deviation) in group 1 and 13.2+/-2.1 mm Hg in group 2. Postoperatively, IOP increased to a mean maximum of 20.6+/-5.5 mm Hg in group 1 and 31.5+/-3.5 mm Hg in group 2 (P<0.01 for both groups). The difference between groups was also significant (P<0.05). Five of 14 eyes (36%) in group 1 and 10 of 13 eyes (77%) in group 2 had an elevation of IOP exceeding 21 mm Hg (P=0.03). The median interval from surgery to reach maximal IOP was 7 days in both groups. The significant IOP elevation lasted for 3 months in group 1 and 6 months in group 2. CONCLUSIONS: After injecting of TA into the vitreous cavity upon completion of PPV for macular edema, a dose-dependent IOP elevation was observed, starting from early postoperative days and returning to normal values after several months. These results show that intravitreal TA injection in the vitrectomized eyes might have different IOP changes from in the nonvitrectomized eyes.