微创医学

目的评价曲氨萘德玻璃体腔注药联合激光治疗视网膜分支静脉阻塞继发黄斑囊样水肿的临床疗效。方法 66例72眼视网膜分支静脉阻塞继发黄斑囊样水肿患者为研究对象，分为观察组与对照组各33例，观察组行曲氨萘德玻璃体腔注药联合激光治疗，对照组行单纯性激光治疗，比较两组患者治疗前与治疗1、3、6、12月的视力、眼压、黄斑区视网膜平均厚度与黄斑阈值敏感度。结果观察组经治疗后1、3、6与12月平均最佳矫正视力较治疗前均有显著提高，对照组治疗后1月与治疗前无明显变化，治疗后3、6月与治疗前相比，差异有统计学意义（P＜0.05），治疗后12月视力恢复至治疗前水平。两组患者治疗后3～12月眼压均维持至正常水平，差异无统计学意义（P＞0.05）。两组患者术后黄斑区视网膜平均厚度值较治疗前均有降低，差异均有统计学意义（P＜0.05），且观察组各点降低程度高于对照组（P＜0.05）。同时，观察组经治疗后1、3、6与12月黄斑阈值敏感度较治疗前均有显著改善，对照组治疗之后1月与治疗前相比无明显变化，治疗后3、6月与治疗前相比有明显差异（P＜0.05），术后12个月后对照组MTS值恢复至术前水平。结论曲安奈德玻璃体腔联合激光治疗视网膜分支静脉阻塞继发黄斑囊状水肿可明显减少或消除黄斑水肿，促进视网膜功能的恢复，改善视力，疗效更可靠持久。

Objective To investigate the efficacy of intravitreous injection of triamcinolone acetonide combined with laser photocoagulation for cystoid macular edema secondary to branch retinal vein occlusion. Methods A total of 66 patients (72 eyes) with cystoid macular edema secondary to branch retinal vein occlusion were divided into observation group (n=33) and control group (n=33). The patients in the observation group underwent intravitreous injection of triamcinolone acetonide combined with laser photocoagulation, and the patients in the control group underwent simple laser photocoagulation. Before treatment and at 1 month, 3 months, 6 months and 12 months after treatment, comparison of visual acuity, intraocular pressure, average thickness of macular retina and macular threshold sensitivity was conducted between the two groups. Results In the observation group, the average optimum visual acuity was improved significantly at 1 month, 3 months, 6 months and 12 months after treatment compared with the level before treatment. In the control group, compared with the average optimum visual acuity before treatment, no significant change was observed in the level at 1 month after treatment, but differences were found in the levels at 3 months and 6 months after treatment (P＜0.05). And the visual acuity at 12 months after treatment returned to the level before treatment in the control group. At 3 to 12 months after treatment, the intraocular pressure of both groups maintained the normal level, and there was no difference between the two groups (P＞0.05). The postoperative macular retinal thickness of both groups decreased statistically significantly compared with that before treatment (P＜0.05). At each time point, the macular retinal thickness decreased more sharply in the observation group compared with the control group (P＜0.05). In the observation group, the macular threshold sensitivity was improved significantly at 1 month, 3 months and 6 months after treatment compared with that before treatment. In the control group, compared with the macular threshold sensitivity before treatment, no significantly change was observed in the sensitivity at 1 month after treatment, but differences were found in the sensitivity either at 3 and 6 months after treatment (P＜0.05). Macular threshold sensitivity at 12 months after treatment returned to the level before treatment in the control group. Conclusions For patients with cystoid macular edema secondary to branch retinal vein occlusion, intravitreous injection of triamcinolone acetonide combined with laser photocoagulation can obviously reduce or eliminate macular edema, promote the recovery of retinal function, improve the visual acuity and provide reliable and durable efficacy.