目的:讨论曲安奈德(triamcinolone acetonide,TA)在增生性糖尿病视网膜病变(proliferate diabetic retinopathy,PDR)玻璃体切除术(pars plana vitrectomy,PPV)中的辅助作用。方法:增生性糖尿病视网膜病变患者107例107眼随机分为曲安奈德玻璃体切除组(治疗组53眼)和传统玻璃体切除组(对照组54眼),其中TA组经大部分玻璃体切除后,术中抽取0.3~0.5mLTA注入玻璃体腔,完成余下玻璃体皮质切除及视网膜前膜的剥离。观察术中并发症如视网膜裂孔形成、视网膜脱离、玻璃体出血。术后最佳矫正视力(BCVA)、眼压、黄斑水肿情况。结果:总共有104例(97.2%)患者完成6~12mo随访,其中TA组51例(96.2%),传统玻璃体切除组53例(98.1%)。TA组术中视网膜裂孔明显低于对照组(P<0.05),术中视网膜脱离、玻璃体出血及术后BCVA、眼压、黄斑水肿两组无明显差异。结论:增生性糖尿病视网膜病变玻璃体切除时注射TA能够加玻璃体皮质的可视性,使视网膜前膜的剥离更安全有效,减少术中视网膜破裂,术后没有与之相关的严重不良反应。

AIM: To discuss the role of the triamcinolone acetonide(TA)injection applied in the pars plana vitrectomy(PPV) surgery for proliferate diabetic retinopathy(PDR). METHODS: A prospective controlled clinical study was carried out on 107 eyes from 107 patients with PDR,with 53 patients undergoing TA-assisted PPV and 54 patients in control group undergoing conventional PPV.The retinal break,retinal detachment,vitreous hemorrhage were obeserved and recorded during operation.After treatment, the changes in best-corrected visual acuity (BCVA), intraocular pressure (IOP), macular edema were recorded. RESULTS:Total 104 patients(97.2%) were followed-up for 6-12 months,51 patients(96.2%) in TA-assisted PPV, 53 patients(98.1%) in conventional PPV. The incidence of retinal breaks was significantly lower in TA-assisted PPV than in conventional PPV(P<0.05). Retinal breaks were seen in 3 eyes(5.7%)undergoing TA-assisted PPV compared with 11 eyes (20.4%) undergoing conventional PPV.Retinal detachment,vitreous hemorrhage during operation,and the BCVA,IOP, macular edema after treatment all had no significiant difference. CONCLUSION: TA-assisted PPV offers improved visu- alization, and allows surgeons to excise the epiretinal membrane(ERM) safely and effectively,reduces the incidence of retinal breaks during the surgical management of PVR for PDR. There were no serious adverse events related to the intraoperative use of TA.