目的:寻找玻璃体内注射曲安奈德(TA)治疗糖尿病性黄斑水肿(diabeticmacularedema,DME)的最小有效剂量。方法:选择FFA证实为DME的患者38例45眼,将其随机分为两组:A组19例22眼,B组19例23眼。两组分别采用40g/L的TA2mg和4mg玻璃体内注射。治疗前两组的平均最佳矫正视力(BCVA)分别为0.06±0.06和0.06±0.05(t=0.076,P=0.94),并且眼压<21mmHg。用药后随访6mo,对比观察用药前后的视力、眼压、晶状体和眼底改变以及FFA表现。结果:治疗后平均BCVA:A组22眼为0.13±0.05,B组23眼为0.12±0.04;两组患者治疗前后比较差异均有统计学意义(t=-4.39,P=0.00;t=-5.75,P=0.00)。用药后眼压>21mmHgA组2眼(9%),B组9眼(39%),高眼压发生率的差异有统计学意义(χ2=3.99,P=0.04)。FFA显示治疗有效A组为19眼,B组22眼,两组有效率差别无统计学意义(χ2=0.32,P=0.56)。在6mo内复发率A组5眼(23%),B组3眼(13%),其差异无统计学意义(χ2=0.21,P=0.64)。两组中均无发生难治性青光眼和白内障发展眼。黄斑水肿复发眼再次玻璃体内注射TA有效。结论:玻璃体内注射TA2mg或4mg对于DME均有一定疗效,其短期复发率没有明显差异。玻璃体内注射2mgTA较注射4mg能较少引起眼压升高。

AIM:To look for the minimum effective dosage of intravitreal injection with triamcinolone acetonide(TA) for diabetic macular edema(DME).METHODS:A total of 45 eyes in 38 DME patients who were diagnosed by FFA were collected.They were divided into two groups:22 eyes in group A and the other 23 eyes in group B.Different dosage of 40g/L TA(2mg or 4mg) were respectively used for intravitreal injection for the two groups.Before the treatment,the average best-corrected visual acuity(BCVA) was 0.06±0.06 and 0.06±0.05 in the two groups respectively(t=0.076,P=0.94),and all the intraocular pressure(IOP) was below 21mmHg.The average follow-up duration was 6 months after treatment.The BCVA,IOP,changes of lens and ocular fundus and FFA before and after treatment were observed.RESULTS:The average BCVA after treatment was 0.13±0.05 and 0.12±0.04 in the two groups respectively.The differences caused by treatment for each group were statistically significant(t=-4.39,P=0.00;t=-5.75,P=0.00).The hypertension rate was 9%(2 eyes) in group A and 39%(9 eyes) in group B(χ2=3.99,P=0.04).For 19 eyes in group A and 22 eyes in group B,the treatment showed effective by FFA(χ2=0.32,P=0.56).The recurrence rate was 23% and 13% respectively,the difference was not statistically significant(χ2=0.21,P=0.64).No refractory glaucoma and cataract development eye occurred.Intravitreous injection with TA again was effective if macular edema recurred.CONCLUSION:No matter the dosage is 2mg or 4mg,intravitreous injection with TA is a promising therapeutic method for DME,its short-term recurrence rate is not obviously different.But 2mg TA injection may cause less increased IOP than 4mg TA injection.

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