脉络膜脱离型视网膜脱离术前玻璃体腔注射曲安奈德的临床疗效

Analysis of intravitreal injection of triamcinolone acetonide before vitrectomy for retinal detachment associated with choroidal detachment

摘要:

目的：探讨术前玻璃体腔注射曲安奈德对微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的临床疗效。

方法：选择我院2015-01/2016-06 临床确诊的脉络膜脱离型视网膜脱离患者23例23眼，入院后先行玻璃体腔内注射曲安奈德4～5d后行23G玻璃体切割和硅油填充术。观察手术前后视力、眼压情况，以及术后视网膜复位率和并发症情况。随诊6～9mo。

结果：曲安奈德注射后前房反应均减轻，眼压升高，由入院眼压4.02±1.47mmHg升高到术前13.69±4.68mmHg，术后升高到17.72±5.88mmHg，入院时眼压与术前和术后比较，差异均有统计学意义(P<0.05)。患者术后末次随访视力较术前均有所改善，视力术后≥0.3者9眼(39%)，术后≥0.05者18眼(78%)。术后1wk，1、3mo和末次随访矫正视力与术前比较，差异均有统计学意义(P<0.05)。视网膜复位情况：手术后2wk有23眼(100%)全视网膜在位，一次视网膜解剖复位率87%，二次视网膜解剖复位率100%。术后1mo时3眼出现下方视网膜局限性脱离，经二次手术巩膜外垫压后视网膜复位。无眼内出血、医源性视网膜裂孔、眼内感染、晶状体损伤等并发症。术后一过性高眼压7眼，均出现在术后12～14d，减少局部激素滴眼液使用和点用降眼压滴眼液后，眼压控制在正常范围。

结论：术前玻璃体腔注射曲安奈德进行预手术处理，能够提高微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效，降低手术难度，提高视力，避免了全身使用激素的副作用。

Abstract:

AIM:To observe the clinical effects of intravitreal injection of triamcinolone acetonide(TA)before vitrectomy for retinal detachment associated with choroidal detachment.

METHODS: Totally 23 cases(23 eyes)of retinal detachment associated with choroidal detachment in our hospital were treated by intravitreal injection of TA 4-5d before 23-Gauge micro-invasive vitrectomy combined with silicone oil injection. All the cases were followed up between 6 to 9mo. The anatomic retinal reattachment, visual acuity, intraocular pressure and postoperative complications were observed and analyzed.

RESULTS: After the surgery, the visual acuity of all patients were improved, with 9 eyes better than 0.3(39%), and 18 eyes better than 0.05(78%). The BCVA at 1wk, 1 and 3mo and last follow up were different compared with before operations(P<0.05). The mean intraocular pressure was 4.02±1.47mmHg before injection, 13.69±4.68mmHg before operation(P<0.05), and 17.72±5.87 mmHg after operation(P<0.05). The retina of all patients treated were reattached 2wk post-operatively. The retinal reattachment rate after the primary surgery and the secondary surgery was 87% and 100%, respectively. Post-operative complications included 7 eyes of transient high intraocular pressure, occurred during 12-14d after operations and returned to normal after less glucocorticoid eye drops and giving IOP lowering drugs. There were no intraocular hemorrhage, iatrogenic retinal breaks, infections, or lens injuries.

CONCLUSION: Intravitreal injection of TA before vitrectomy for retinal detachment associated with choroidal could improve the clinical effects, and decrease the difficulty of surgery while the injection itself is pretty safe.