Intravitreal triamcinolone for refractory diabetic macular edema
Intravitreal triamcinolone for refractory diabetic macular edema
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DOI：
10.1016/s0161-6420(02)00975-2
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发表时间：
2002-05-01
期刊：
影响因子：
13.7
通讯作者：
Baumal, C
中科院分区：
文献类型：
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作者：
Martidis, A;Duker, JS;Baumal, C
目的：确定玻璃体内注射曲安奈德治疗糖尿病黄斑水肿是否安全有效。设计：前瞻性、非对照、干预性病例系列。参与者：16只眼，临床上对至少两次激光治疗无效的糖尿病黄斑水肿(CSME)。方法：根据早期治疗糖尿病视网膜病变研究指南，诊断为CSME并至少进行两次激光光凝治疗。在首次激光治疗至少6个月后，通过临床检查和光学相干断层扫描(OCT)评估疗效。对于黄斑中心残留厚度大于300微米(正常，200微米)且视力从基线水平丧失的眼，给予4 mg曲安奈德玻璃体内注射。观察患者的视觉和解剖反应，以及与注射程序和皮质类固醇药物相关的并发症。主要观察指标：评估视力和OCT黄斑增厚的定量变化。监测潜在并发症，包括眼压反应、白内障进展、视网膜脱离、玻璃体出血和眼内炎。结果：所有患者均完成了3个月的随访，其中8例(50%)完成了6个月以上的随访。在1、3和6个月的随访间隔中，分别测量2.4、2.4和1.3行Snellen线的平均视力改善。OCT测量的中心黄斑厚度在相同的时间间隔内分别比治疗前的540.3微米(+/-96.3um)减少了55%、57.5%和38%。在这段时间内，分别有5只眼、3只眼和1只眼的眼压超过21毫米汞(S)。一只眼在6个月时表现出白内障进展。平均随访6.2个月，未发现其他并发症。结论：玻璃体腔内注射曲安奈德是治疗常规激光治疗无效的糖尿病黄斑水肿的一种有效方法。并发症似乎并不令人望而却步。有必要进行进一步的研究，以评估其长期疗效和安全性，以及再次治疗的必要性。眼科2002；美国眼科学会109：920-927(C)2002。
Purpose: To determine if intravitreal injection of triamcinolone acetonide is safe and effective in treating diabetic macular edema unresponsive to prior laser photocoagulation.Design: Prospective, noncomparative, interventional case series.Participants: Sixteen eyes with clinically significant diabetic macular edema (CSME) that failed to respond to at least two previous sessions of laser photocoagulation.Methods: Eyes were diagnosed with CSME and treated with at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines. At least 6 months after initial laser therapy, the response was measured by clinical examination and optical coherence tomography (OCT). Eyes with a residual central macular thickness of more than 300 mum (normal, 200 mum) and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. The visual and anatomic responses were observed as well as complications related to the injection procedure and corticosteroid medication.Main Outcome Measures: Visual acuity and quantitative change in OCT macular thickening were assessed. Potential complications were monitored, including intraocular pressure response, cataract progression, retinal detachment, vitreous hemorrhage, and endophthalmitis.Results: All patients completed 3 months of follow-up, and 8 of 16 patients (50%) completed 6 or more months of follow-up. Mean improvement in visual acuity measured 2.4, 2.4, and 1.3 Snellen lines at the 1-, 3-, and 6-month follow-up intervals, respectively. The central macular thickness as measured by OCT decreased by 55%, 57.5%, and 38%, respectively, over these same intervals from an initial pretreatment mean of 540.3 mum (+/-96.3 mum). Intraocular pressure exceeded 21 mmHg in 5, 3, and 1 eye(s), respectively, during these intervals. One eye exhibited cataract progression at 6 months. No other complications were noted over a mean follow-up of 6.2 months. Reinjection was performed in 3 of 8 eyes after 6 months because of recurrence of macular edema.Conclusions: Intravitreal triamcinolone is a promising therapeutic method for diabetic macular edema that fails to respond to conventional laser photocoagulation. Complications do not appear to be prohibitive. Further study is warranted to assess the long-term efficacy and safety, and the need for retreatment. Ophthalmology 2002;109:920-927 (C) 2002 by the American Academy of Ophthalmology.