Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion
Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion
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DOI：
10.1001/archopht.122.8.1131
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发表时间：
2004-08-01
影响因子：
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通讯作者：
Puliafito, CA
中科院分区：
文献类型：
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作者：
Ip, MS;Gottlieb, ML;Puliafito, CA
目的：探讨玻璃体内注射曲安奈德治疗视网膜中央静脉阻塞（CRVO）相关性黄斑水肿的安全性和有效性。方法：我们回顾了威斯康星州大学和巴斯科姆帕尔默眼科研究所连续13例（13只眼）接受玻璃体内注射曲安奈德（4 mg）治疗的CRVO相关性黄斑水肿患者的病历。每次玻璃体内注射使用27号或30号针头通过睫状体平坦部进行。主要结果测量：Snellen视力的变化，黄斑水肿的临床表现，用光学相干断层扫描（OCT）测量中心凹增厚，以及并发症的频率。13例患者的中位年龄为67岁（四分位距，57-77岁），注射前症状的中位持续时间为8个月（四分位距，4-9个月）。患眼的平均基线视力为20/500。6个月随访检查时患眼的平均视力为20/180。所有13例患者均完成了6个月的检查。非缺血性CRVO眼（n = 5）显示视力显著改善，而缺血性CRVO眼（n = 8）显示视力无显著改善。无患者视力下降。OCT测量的平均基线中心凹厚度为590 μ m（视网膜增厚= 416 μ m）。12例患者在1个月随访检查时通过OCT测量的平均中心凹厚度为212 μ m（视网膜增厚= 38 μ m）。在3个月的随访检查中，13名患者通过OCT测量的平均中心凹厚度为193 mum（视网膜增厚= 19 mum）。在3个月和6个月的随访检查之间，4例患者发生了黄斑水肿复发。4例患者中有3例再次注射曲安奈德。这3例患者中有2例在再次治疗后视力改善。在6个月的随访检查中，13例患者通过OCT测量的平均中心凹厚度为281 μ m（视网膜增厚= 107 μ m）。未发生视网膜脱离或眼内炎等不良反应。一名患者经历了眼内压的增加，控制与2水suppressants.Conclusions：玻璃体内注射曲安西龙似乎是一种可能有效的治疗与CRVO相关的黄斑水肿的一些患者。非缺血性CRVO患者的反应可能比缺血性CRVO患者更好，某些患者可能需要再次治疗。在该病例系列中，未观察到严重并发症。
Objective: To investigate the safety and efficacy of intravitreal triamcinolone acetonide as treatment for macular edema associated with central retinal vein occlusion (CRVO).Methods: We reviewed the medical records of 13 consecutive patients (13 eyes) with macular edema associated with CRVO who were treated with an injection of intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsin and the Bascom Palmer Eye Institute. each intravitreal injection was delivered through the pars plana using a 27- or 30-gauge needle.Main Outcome Measures: Change in Snellen visual acuity, clinical appearance of macular edema, measurement of foveal thickening with optical coherence tomography (OCT), and frequency of complications.Results: The median age of the 13 patients was 67 years (interquartile range, 57-77 years), and the median duration of symptoms before injection was 8 months (interquartile range, 4-9 months). Mean baseline visual acuity was 20/500 in the affected eye. Mean visual acuity at the 6-month follow-up examination was 20/180 in the affected eye. All 13 patients completed the 6-month examination. Eyes with nonischemic CRVO (n = 5) demonstrated a significant improvement in visual acuity, whereas eyes with ischemic CRVO (n = 8) demonstrated a nonsignificant visual acuity improvement. No patient had a de-crease in visual acuity. Mean baseline foveal thickness as measured by OCT was 590 mum (retinal thickening = 416 mum). Mean foveal thickness as measured by OCT at the 1-month follow-up examination in 12 patients was 212 mum (retinal thickening = 38 mum). At the 3-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 193 mum (retinal thickening = 19 mum). Between the 3- and 6-month follow-up examinations, 4 patients developed a recurrence of macular edema. Three of the 4 patients were retreated with a second injection of triamcinolone. Two of these 3 patients experienced an improvement in visual acuity following retreatment. At the 6-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 281 mum (retinal thickening = 107 mum). No adverse effects such as retinal detachment or endophthalmitis occurred. One patient experienced an increase in intraocular pressure that was controlled with 2 aqueous suppressants.Conclusions: Intravitreal injection of triamcinolone appears to be a possibly effective treatment in some patients with macular edema associated with CRVO. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO, and retreatment may be necessary in some patients. In this case series, severe complications were not noted.