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目的:探讨玻璃腔内注射曲安奈德结合真武汤加减治疗视盘血管炎继发黄斑水肿的临床疗效及安全性。方法:选择2013年12月到2017年4月在我院诊治的视盘血管炎继发黄斑水肿患者142例(142眼)作为研究对象,根据信封随机抽签法分为观察组与对照组,每组各71例。对照组给予玻璃腔内注射曲安奈德治疗,观察组在对照组治疗的基础上给予真武汤加减治疗。治疗1个月后,比较两组治疗前后视力、黄斑中心凹厚度的变化情况及不良反应的发生情况。结果:治疗后,观察组与对照组的视力均明显优于治疗前(P<0.05),且观察组视力明显优于对照组(P<0.05)。治疗后,观察组与对照组的黄斑中心凹厚度分别为168.34±22.19μm和267.35±34.11μm,均明显低于治疗前[516.35±45.20μm和522.14±23.01μm](P<0.05),且观察组治疗后黄斑中心凹厚度明显低于对照组(P<0.05)。两组治疗后发生玻璃体积血、新生血管性青光眼、瞳孔区模性渗出等并发症,发生率对比差异无统计学意义(P>0.05)。结论:与单用玻璃腔内注射曲安奈德治疗相比,玻璃腔内注射曲安奈德结合真武汤加减治疗视盘血管炎继发黄斑水肿的安全性更高,且能有效减轻黄斑水肿,缩小黄斑区域,提高视力。
Objective: To investigate the clinical efficacy and safety of intravitreous injection of triamcinolone acetonide combined with Zhenwu Decoction for the treatment of macular edema caused by optic disc vasculitis. METHODS: A total of 142 patients (142 eyes) with macular edema secondary to optic disc vasculitis treated in our hospital from December 2013 to April 2017 were selected as the study subjects and divided into observation group and control group according to random sampling of envelopes. Each group 71 cases each. The control group was given intravitreal injection of triamcinolone acetonide, and the observation group was treated with Zhenwu Decoction on the basis of the control group. After 1 month of treatment, the changes of visual acuity, foveal thickness and incidence of adverse reactions were compared between the two groups before and after treatment. Results: After treatment, the visual acuity of the observation group and the control group were significantly better than before treatment (P <0.05), and the visual acuity of the observation group was significantly better than that of the control group (P <0.05). After treatment, the foveal thickness of the observation group and the control group were 168.34 ± 22.19μm and 267.35 ± 34.11μm, which were significantly lower than those before treatment [516.35 ± 45.20μm and 522.14 ± 23.01μm] (P <0.05) The foveal thickness of the foveal group was significantly lower than that of the control group (P <0.05). Complications of vitreous hemorrhage, neovascular glaucoma and modeled exudation of pupil area occurred after treatment in both groups, with no significant difference in incidence (P> 0.05). Conclusion: Compared with single intravitreal triamcinolone acetonide injection, intravitreal injection of triamcinolone combined with Zhenwu Decoction for the treatment of optic disc vasculitis secondary to macular edema is more safe, and can effectively reduce macular edema, reduce macular Area, improve eyesight.