多波长激光联合玻璃体腔内注射曲安奈德治疗视网膜静脉阻塞的疗效观察(1)
[摘要] 目的:观察多波长激光光凝视网膜联合玻璃体腔内注射曲安奈德(TA)治疗视网膜静脉阻塞(RVO)的临床疗效。方法:45例患者中,眼底荧光血管造影(FFA)检查有明确的无灌注区(NP区)且≥5PD及(或)有视盘、视网膜、虹膜新生血管者,立即给予多波长激光光凝治疗;光学相干断层扫描(OCT)显示黄斑水肿≥450 μm,或视网膜出血较多,FFA检查显示大面积遮蔽荧光者,行玻璃体腔内注射TA 4 mg治疗,术后定期观察视力、眼压、虹膜、瞳孔、黄斑水肿、视网膜新生血管及无灌注区情况, 随访3～21个月。结果:多波长激光光凝治疗视网膜静脉阻塞患者17例(包括玻璃体腔内注射TA后随访过程中出现视盘、视网膜、虹膜新生血管者8例),视力均有不同程度提高,黄斑水肿明显改善,NP区及视盘、视网膜、虹膜新生血管消退,血管渗漏消失;玻璃体腔内注射曲安奈德36例,视力均有不同程度提高,OCT检查视网膜厚度改变,黄斑部厚度在注药后逐渐下降,早期改变明显,黄斑部厚度2.5～3个月时接近正常并逐渐稳定,FFA检查提示血管渗漏减轻。结论:多波长激光光凝视网膜联合玻璃体腔内注射TA是治疗RVO的一种行之有效的治疗手段,部分患者可出现高眼压、黄斑水肿复发等并发症。
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[关键词] 视网膜静脉阻塞;多波长激光;曲安奈德
[中图分类号]R774.1 [文献标识码]B [文章编号]1673-7210(2010)04(a)-105-03
Clinical observation of combination of multiwavelength laser and intravitreous injection of Triamcinolone Acetonide for retinal vein occlusion
WANG Tao
(Linyi People's Hospital, Shandong Province, Linyi276003, China)
[Abstract] Objective: To observe the clinical efficacy of combination of intravitreous injection of Triamcinolone Acetonide (TA) and multiwavelength laser therapy for macular edema due to retinal vein occlusion (RVO). Methods: In 45 patients, multiwavelength laser therapy were given immediately if fluorescence fundus angiography indicates definite nonperfusion (NP) and NP≥5PD and (or) with neovascular in optic disc, retina or iris; intravitreous injection of TA 4 mg if optic coherent tomography (OCT) indicates the thickness of macular ≥450 μm or FFA indicates large area of blocked fluorescence due to much hemorrhage. Then the vision, ophthalmotonus, iris, pupilla, macular thickness, retinal neovacular periodically during 3-21 months follow-up. Results: 17 eyes were given multiwavelength laser therapy (includes 8 eyes which have neovascular in optic disk, iris or retina disappeared during the follow-up of intravitreous injection of TA). The vision of these eyes elevated with different degrees. Macular edema improved obviously. NP and neovascular of optic disc, iris and retina extincted and vessel leakage disappeared. 36 eyes were given intravitreous injection of TA. Their vision elevated also. OCT examination indicates the thickness of macular decreased gradually. The change in earier period was obvious and the thickness of the macular was almost normal and stable gradually after 2-3.5 months follow-up, FFA indicates the vassel leakage extenuates. Conclusion: Combination of multiwavelength laser and intravitreous injection of TA therapy for retinal vein occlusion is an efficacious clinical therapy and intraocular hypertension and recurtion of macular edema can oppear in part patients.
, 百拇医药
[Key words] Retinal vein occlusion; Multiwavelength laser; Triamcinolone Acetonide
视网膜静脉阻塞(RVO)致阻塞区视网膜及黄斑区出血、水肿,从而引起视力下降。2007年8月～2009年2月,笔者对45例(45只眼)RVO患者行多波长激光光凝缺血区视网膜联合玻璃体腔内注射曲安奈德(TA,意大利KenacortA公司)治疗,取得满意效果,现报道如下:
1 资料与方法
1.1 一般资料
选择2007年8月～2009年2月就诊于我院的RVO患者45例(45只眼),年龄19～64岁,平均51岁;男21例,女24例;其中,视网膜中央静脉阻塞(CRVO)14例,视网膜分支静脉阻塞(BRVO)31例,29例患者伴有高血压、动脉硬化及糖尿病,请内科会诊,针对原发病进行治疗,随访3～21个月,平均11个月。
, http://www.100md.com
1.2 方法
所有经治患者均行视力、眼压、虹膜、瞳孔、眼底、光学相干断层扫描(OCT)、眼底荧光血管造影(FFA)检查,FFA检查有明确的无灌注区(NP区)且≥5PD和(或)有视盘、视网膜、虹膜新生血管者,立即给予多波长激光光凝治疗,CRVO做全视网膜光凝,BRVO做病灶区光凝,根据患者屈光间质浑浊程度、视网膜不同部位选择不同波长激光,光凝次数每例2～6次,平均3次,光凝时间为0.15～0.20 s,光斑100～500 μm,能量120～300 mW,Ⅱ～Ⅲ级光斑反应,光凝点数:根据病变范围点数不一,全视网膜光凝者2 000～2 500点,激光治疗时,先避开出血浓密、水肿明显处,待出血吸收、水肿减轻后再行补充光凝)。分别于光凝完成后2周及1、3、6、12月复查,观察视力、眼压、虹膜、瞳孔、眼底、OCT,第2.5～3个月复查FFA,随访3～21个月,平均11个月。, 百拇医药(王 涛)
, http://www.100md.com
[关键词] 视网膜静脉阻塞;多波长激光;曲安奈德
[中图分类号]R774.1 [文献标识码]B [文章编号]1673-7210(2010)04(a)-105-03
Clinical observation of combination of multiwavelength laser and intravitreous injection of Triamcinolone Acetonide for retinal vein occlusion
WANG Tao
(Linyi People's Hospital, Shandong Province, Linyi276003, China)
[Abstract] Objective: To observe the clinical efficacy of combination of intravitreous injection of Triamcinolone Acetonide (TA) and multiwavelength laser therapy for macular edema due to retinal vein occlusion (RVO). Methods: In 45 patients, multiwavelength laser therapy were given immediately if fluorescence fundus angiography indicates definite nonperfusion (NP) and NP≥5PD and (or) with neovascular in optic disc, retina or iris; intravitreous injection of TA 4 mg if optic coherent tomography (OCT) indicates the thickness of macular ≥450 μm or FFA indicates large area of blocked fluorescence due to much hemorrhage. Then the vision, ophthalmotonus, iris, pupilla, macular thickness, retinal neovacular periodically during 3-21 months follow-up. Results: 17 eyes were given multiwavelength laser therapy (includes 8 eyes which have neovascular in optic disk, iris or retina disappeared during the follow-up of intravitreous injection of TA). The vision of these eyes elevated with different degrees. Macular edema improved obviously. NP and neovascular of optic disc, iris and retina extincted and vessel leakage disappeared. 36 eyes were given intravitreous injection of TA. Their vision elevated also. OCT examination indicates the thickness of macular decreased gradually. The change in earier period was obvious and the thickness of the macular was almost normal and stable gradually after 2-3.5 months follow-up, FFA indicates the vassel leakage extenuates. Conclusion: Combination of multiwavelength laser and intravitreous injection of TA therapy for retinal vein occlusion is an efficacious clinical therapy and intraocular hypertension and recurtion of macular edema can oppear in part patients.
, 百拇医药
[Key words] Retinal vein occlusion; Multiwavelength laser; Triamcinolone Acetonide
视网膜静脉阻塞(RVO)致阻塞区视网膜及黄斑区出血、水肿,从而引起视力下降。2007年8月～2009年2月,笔者对45例(45只眼)RVO患者行多波长激光光凝缺血区视网膜联合玻璃体腔内注射曲安奈德(TA,意大利KenacortA公司)治疗,取得满意效果,现报道如下:
1 资料与方法
1.1 一般资料
选择2007年8月～2009年2月就诊于我院的RVO患者45例(45只眼),年龄19～64岁,平均51岁;男21例,女24例;其中,视网膜中央静脉阻塞(CRVO)14例,视网膜分支静脉阻塞(BRVO)31例,29例患者伴有高血压、动脉硬化及糖尿病,请内科会诊,针对原发病进行治疗,随访3～21个月,平均11个月。
, http://www.100md.com
1.2 方法
所有经治患者均行视力、眼压、虹膜、瞳孔、眼底、光学相干断层扫描(OCT)、眼底荧光血管造影(FFA)检查,FFA检查有明确的无灌注区(NP区)且≥5PD和(或)有视盘、视网膜、虹膜新生血管者,立即给予多波长激光光凝治疗,CRVO做全视网膜光凝,BRVO做病灶区光凝,根据患者屈光间质浑浊程度、视网膜不同部位选择不同波长激光,光凝次数每例2～6次,平均3次,光凝时间为0.15～0.20 s,光斑100～500 μm,能量120～300 mW,Ⅱ～Ⅲ级光斑反应,光凝点数:根据病变范围点数不一,全视网膜光凝者2 000～2 500点,激光治疗时,先避开出血浓密、水肿明显处,待出血吸收、水肿减轻后再行补充光凝)。分别于光凝完成后2周及1、3、6、12月复查,观察视力、眼压、虹膜、瞳孔、眼底、OCT,第2.5～3个月复查FFA,随访3～21个月,平均11个月。, 百拇医药(王 涛)