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目的观察曲安奈德注射液玻璃体腔注射(IVI)和Tenon囊下给药(STi)治疗糖尿病性黄斑水肿的疗效。设计回顾性病例系列。研究对象37例通过荧光素眼底血管造影(FFA)和相干光断层扫描(OCT)诊断的糖尿病性黄斑水肿患者。方法分别给予一次性曲安奈德(4mg)玻璃体腔注射(n=19)或三次(0d、2w、4w)Tenon囊下给药(40mg/次)(n=18)。治疗后4、8、12、16、20、24w复查最佳矫正视力、眼底、眼压、FFA、OCT,评价其疗效。主要指标视力、视网膜黄斑中心凹厚度、眼压。结果32例患者完成了24周的观察研究。IVI组治疗前及治疗后24周的视力分别为(0.10±0.03)、(0.24±0.06)(F=15.459,P=0.000);黄斑中心凹视网膜厚度分别为(460.73±46.33)μm、(394.53±41.43)μm(F=25.282,P=0.0000)。STi组治疗前及治疗后24周的视力分别为(0.11±0.04)、(0.18±0.07)(F=6.989,P=0.000);黄斑中心凹视网膜厚度分别为(454.76±56.28)μm、(424.94±42.69)μm(F=5.145,P=0.000)。同一时间点,IVI的治疗效果较STi更显著,差异具有统计学意义(P均<0.05)。两组患者未出现严重、不可逆转并发症。结论曲安奈德玻璃体腔注射和Tenon囊下多次给药均是治疗糖尿病性黄斑水肿的有效方法;玻璃体腔注射效果更显著,Tenon囊下给药更安全。
Objective To observe the efficacy of intravitreous injection of triamcinolone acetonide (IVI) and subconjunctival Tenon (STi) in the treatment of diabetic macular edema. Design retrospective case series. Participants 37 patients with diabetic macular edema diagnosed by fluorescein fundus angiography (FFA) and coherence tomography (OCT). Methods One-time administration of triamcinolone acetonide (4 mg) intravitreally (n = 19) or three times (0 d, 2 w, 4 w) subcutaneously (40 mg once daily) 4,8,12,16,20,24w after treatment review the best corrected visual acuity, ocular fundus, intraocular pressure, FFA, OCT, evaluate its efficacy. The main indicators of vision, retinal foveal thickness, intraocular pressure. Results 32 patients completed the 24-week observation study. The visual acuity of the IVI group before and 24 weeks after treatment were (0.10 ± 0.03) and (0.24 ± 0.06), respectively (F = 15.459, P = 0.000). The foveal retinal thickness in the IVI group was (460.73 ± 46.33) μm and ± 41.43) μm (F = 25.282, P = 0.0000). The visual acuity of STi group before and 24 weeks after treatment was (0.11 ± 0.04) and (0.18 ± 0.07), respectively (F = 6.989, P = 0.000). The foveal retinal thickness was (454.76 ± 56.28) μm and ± 42.69) μm (F = 5.145, P = 0.000). At the same time point, IVI treatment effect was more significant than STi, the difference was statistically significant (P all <0.05). Two groups of patients did not appear serious, irreversible complications. Conclusion Intravitreal injection of triamcinolone acetonide and multiple subconjunctival administration of Tenon are effective methods for the treatment of diabetic macular edema. Intravitreal injection is more effective and the administration of Tenon capsule is safer.