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[摘要]
目的：探讨术前注射曲安奈德(TA)联合25G微创玻璃体视网膜手术(vitreoretinal surgery，VRS)治疗增生型糖尿病性视网膜病变(proliferative diabetic retinopathy，PDR)的效果。
方法：选取我院眼科需行VRS治疗的PDR患者108例108眼随机分为两组，VRS+TA组： VRS术前1wk行玻璃体腔注射TA的患者54例； VRS组：直接行VRS治疗患者54例，比较两组患者手术情况、术前、术后3mo裸眼视力、最佳矫正视力，术前、术后1wk，1、 3mo眼压和并发症情况。
结果：VRS+TA组手术时间、电凝率、医源性裂孔率和术中出血率显著短于或低于VRS组，差异有统计学意义(P<0.05)，而两组患者眼内填充物比较无统计学差异(P>0.05)； 两组患者术后3mo裸眼视力和最佳矫正视力较术前均得到显著提高，差异有统计学意义(P<0.05)，两组间比较差异无统计学意义(P>0.05)； VRS+TA组术后1、3mo眼压较术前显著升高，差异有统计学意义(P<0.05)，两组间比较差异无统计学意义(P>0.05)； VRS+TA组前房渗出率显著低于VRS组，差异有统计学意义(P<0.05)，但两组并发症总发生率差异无统计学意义(P>0.05)。
结论：PDR患者行VRS治疗前1wk注射TA，可降低手术难度，缩短手术时间，并减少术中、术后并发症，利于患者术后视力改善。
[Key word]
[Abstract]
AIM: To investigate the effect of preoperative injection of triamcinolone acetonide(TA)with 25G minimally invasive vitreoretinal surgery(VRS)in treating proliferative diabetic retinopathy(PDR)and the prognosis of patients.
METHODS: A total of 108 patients(108 eyes)with PDR to be treated by VRS were randomly divided into two groups. Fifty-four patients, treated with intravitreal injection of TA at 1wk before surgery were included into the VRS+TA group, and 54 cases directly treated by VRS were included into the VRS group. The surgical effect, uncorrected visual acuity(at 3mo after surgery), the best corrected visual acuity, the intraocular pressure(before surgery and at 1wk, 1 and 3mo after surgery)and complications were observed.
RESULTS: The surgical time, electrocoagulation rate, rate of iatrogenic hole and bleeding rate during surgery were significantly shorter or lower in VRS+TA group than in VRS group(P<0.05)while the intraocular filler showed no significant difference between the two groups(P>0.05). At 3mo after surgery, the uncorrected visual acuity and the best corrected visual acuity were improved significantly(P<0.05)while there was no significant difference between groups(P>0.05). At 1 and 3mo after surgery, the intraocular pressure of VRS+TA group was significantly higher than that before surgery(P<0.05)while there were no significant differences between groups(P>0.05). The rate of anterior chamber exudation was significantly lower in VRS+TA group than in VRS group(P<0.05)while there was no significant difference in the total incidence of complications between groups(P>0.05).
CONCLUSION: The application of intravitreal injection of TA in patients with PDR at 1wk before surgery can reduce the difficulty of surgery, shorten the surgical time and reduce complications, which is beneficial to the improvement of visual acuity after surgery.
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