术中前房注射曲安奈德在糖尿病性白内障中的应用
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摘要
目的探讨术中前房注射曲安奈德在糖尿病性白内障中的应用。方法选取2012年1月～2018年2月眼科住院治疗的糖尿病性白内障患者72例(72眼),知情同意后采用抛硬币法分成曲安奈德组(n=36)和对照组(n=36)。两组均在在表面麻醉下行超声乳化白内障联合人工晶状体植入术,曲安奈德组术中侧切口注入1 mg曲安奈德和复方平衡盐溶液以维持前房。对照组按常规方法注入复方平衡盐溶液以形成维持前房。观察并比较两组术后角膜水肿、瞳孔粘连、前房纤维蛋白渗出及后囊浑浊的发生率。结果曲安奈德组术后角膜水肿发生率低于对照组(χ~2=4.50,P<0.05)。两组术后瞳孔粘连发生率相接近(χ~2=0.26,P>0.05)。曲安奈德组术后前房轻、中、重度渗出总发生率低于对照组(χ~2=6.77,P<0.01)。曲安奈德组术后后囊浑浊的发生率低于对照组(χ~2=4.13,P<0.05)。结论术中前房注射曲安奈德在糖尿病性白内障中的应用效果较确切,能显著减轻术后角膜水肿和前房纤维蛋白渗出,降低后囊浑浊的发生率。
Objective To discuss the application of triamcinolone acetonide injected into anterior chamber during the operation on diabetic cataract. Methods 72 cases of patients(72 eyes) with diabetic cataract, who were given the medical treatment in Department of Ophtalmology from January 2012 to February 2018, were selected, and divided into triamcinolone acetonide group(n=36) and control group(n=36) by tossing the coin after the informed consent. The patients in two groups were given phacoemulsificationcataract extraction combined with intraocular lens implantation under topical anesthesia, while the patients in triamcinolone acetonide group were given 1 mg triamcinolone acetonide and compound equilibrium salt solution, which were injected into lateral incision, to maintain anterior chamber. The occurrence rates of corneal edema, caligo pupillae, fibrous exudation of the anterior chamber and again capsulorhexis of patients in two groups were observed and compared after the operation. Results The occurrence rate of corneal edema after the operation of patients in triamcinolone acetonide group was lower than that in control group(χ~2=4.50, P<0.05). The occurrence rates of caligo pupillae in both groups were approximate(χ~2=0.26,P>0.05). The total occurrence rates of light,mediate and severe exudation of anterior chamber of patients in triamcinolone acetonide group after the operation were much lower than those in control group(χ~2=6.77, P<0.01). The occurrence rate of again capsulorhexis of patients in triamcinolone acetonide group after the operation was much lower than that in control group(χ~2=4.13, P<0.05). Conclusion The application of triamcinolone acetonide injected into anterior chamber has reliable curative effect on diabetic cataract during the operation, which can obviously reduce the corneal edema and fibrous exudation of the anterior chamber, as well as the occurrence rate of again capsulorhexis.
Objective To discuss the application of triamcinolone acetonide injected into anterior chamber during the operation on diabetic cataract. Methods 72 cases of patients(72 eyes) with diabetic cataract, who were given the medical treatment in Department of Ophtalmology from January 2012 to February 2018, were selected, and divided into triamcinolone acetonide group(n=36) and control group(n=36) by tossing the coin after the informed consent. The patients in two groups were given phacoemulsificationcataract extraction combined with intraocular lens implantation under topical anesthesia, while the patients in triamcinolone acetonide group were given 1 mg triamcinolone acetonide and compound equilibrium salt solution, which were injected into lateral incision, to maintain anterior chamber. The occurrence rates of corneal edema, caligo pupillae, fibrous exudation of the anterior chamber and again capsulorhexis of patients in two groups were observed and compared after the operation. Results The occurrence rate of corneal edema after the operation of patients in triamcinolone acetonide group was lower than that in control group(χ~2=4.50, P<0.05). The occurrence rates of caligo pupillae in both groups were approximate(χ~2=0.26,P>0.05). The total occurrence rates of light,mediate and severe exudation of anterior chamber of patients in triamcinolone acetonide group after the operation were much lower than those in control group(χ~2=6.77, P<0.01). The occurrence rate of again capsulorhexis of patients in triamcinolone acetonide group after the operation was much lower than that in control group(χ~2=4.13, P<0.05). Conclusion The application of triamcinolone acetonide injected into anterior chamber has reliable curative effect on diabetic cataract during the operation, which can obviously reduce the corneal edema and fibrous exudation of the anterior chamber, as well as the occurrence rate of again capsulorhexis.
引文
[1]谭舟利,范玮.糖尿病白内障术后并发症和手术时机选择[J].华西医学,2017,32(4):612-617.
[2]罗清礼,何为民.使用糖皮质激素患者白内障手术临床观察[J].实用医院临床杂志,2005,2(4):9-10.
[3]朱天夫,张润琦,刘青,等.超声乳化术对糖尿病白内障患者眼表的影响[J].国际眼科杂志,2016,16(12):2209-2212.
[4]宋丽莉.曲安奈德对白内障术后前葡萄膜炎患者的疗效及炎症因子的影响[J].药品评价,2017,14(7):37-40.
[5]郭建全.曲安奈德对年龄相关性白内障术后前葡萄膜炎的疗效及其对炎症因子的影响[J].眼科新进展,2014,34(8):769-771.
[6]陈宇,梁轩伟.结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿的效果[J].国际眼科杂志,2016,16(5):902-904.
[7]Kumar V,Ghosh B,Goel N.Combined laser and intravitreal triamcinolone for proliferative diabetic retinopathy and macular edema[J].Am J Ophthalmol,2009,148(1):171-172.
[8]Giuliari G.Images in clinical medicine.Intravitreal triamcinolone for diabetic macular edema[J].New Engl J Med,2010,363(24):2351.
[9]李绍珍.眼科手术学[M].第2版.北京:人民卫生出版社,2000:359-385.
[10]黄涵.糖尿病性白内障患者两种手术方法疗效和并发症的比较[J].中国现代医生,2007,45(22):40-41.
[11]KrugerAJ,Schauersberger J,Abela C,et al.Two year results:sharp versus rounded optic edges on silicone lenses[J].Cataract Refract Surg,2000,26(4):566-570.
[12]李锐,袁慧敏,刘钊臣,等.葡萄膜炎并发白内障术中前房注射长效糖皮质激素的疗效[J].国际眼科杂志,2016,16(12):2254-2257
[13]Khan A,Petropoulos IN,Ponirakis G,et al.Visual complications in diabetes mellitus:Beyond retinopathy[J].Diabetic Medicine,2017,34(4):478-484.
[14]屈政朋,杨玲.糖尿病白内障患者的临床手术治疗时机与治疗效果分析[J].中国当代医药,2018,25(8):110-112.
[15]陈前.糖尿病合并白内障与老年性白内障临床手术比较[J].昆明医科大学学报,2017,38(3):71-74.
[16]刘辉,孙静淳.前房注射不同剂量曲安奈德预防白内障术后炎症反应的临床分析[J].国外医学医学地理分册,2017,38(4):391-393.
[17]颜少彪,刘忠鑫.曲安奈德对白内障术后前葡萄膜炎患者的疗效及炎症因子的影响[J].中国老年学,2015(9):2532-2533.
[18]刘新书,王敏,赵潺,等.结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿的临床观察[J].中华眼科杂志,2015,51(10):734-738.
[19]Martin Roesel,Carsten Heinz.Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis[J].Graefes Arch Clin Exp Ophthalmo,2010,248(5):715-720.
[20]张岩,孔令普,马军艳,等.玻璃体切割联合曲安奈德染色处理白内障超声乳化术中后囊破裂的效果分析[J].中国实用眼科杂志,2015,33(10):828-830.
[21]Ahmadabadi HF,Mohammadi M,Beheshtnejad H,et al.Effect of intravitreal triamcinolone acetonide injection on central macular thickness in diabetic patients having phacoemulsification[J].J Cataract Refract Surg,2010,36(9)917-922.
[22]Gills JP,Gills P.Effect of intracameral triameinolone to control inflammation following cataract surgery[J].J Cataract Refract Surg,2005,31(8):1670-1671.
[23]Cleary CA,Lanigan B.Intracameral triamcinolone acetonide after pediatric cataract surgery[J].J Cataract Refract Surg,2010,36(10):1676-1681.
[2]罗清礼,何为民.使用糖皮质激素患者白内障手术临床观察[J].实用医院临床杂志,2005,2(4):9-10.
[3]朱天夫,张润琦,刘青,等.超声乳化术对糖尿病白内障患者眼表的影响[J].国际眼科杂志,2016,16(12):2209-2212.
[4]宋丽莉.曲安奈德对白内障术后前葡萄膜炎患者的疗效及炎症因子的影响[J].药品评价,2017,14(7):37-40.
[5]郭建全.曲安奈德对年龄相关性白内障术后前葡萄膜炎的疗效及其对炎症因子的影响[J].眼科新进展,2014,34(8):769-771.
[6]陈宇,梁轩伟.结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿的效果[J].国际眼科杂志,2016,16(5):902-904.
[7]Kumar V,Ghosh B,Goel N.Combined laser and intravitreal triamcinolone for proliferative diabetic retinopathy and macular edema[J].Am J Ophthalmol,2009,148(1):171-172.
[8]Giuliari G.Images in clinical medicine.Intravitreal triamcinolone for diabetic macular edema[J].New Engl J Med,2010,363(24):2351.
[9]李绍珍.眼科手术学[M].第2版.北京:人民卫生出版社,2000:359-385.
[10]黄涵.糖尿病性白内障患者两种手术方法疗效和并发症的比较[J].中国现代医生,2007,45(22):40-41.
[11]KrugerAJ,Schauersberger J,Abela C,et al.Two year results:sharp versus rounded optic edges on silicone lenses[J].Cataract Refract Surg,2000,26(4):566-570.
[12]李锐,袁慧敏,刘钊臣,等.葡萄膜炎并发白内障术中前房注射长效糖皮质激素的疗效[J].国际眼科杂志,2016,16(12):2254-2257
[13]Khan A,Petropoulos IN,Ponirakis G,et al.Visual complications in diabetes mellitus:Beyond retinopathy[J].Diabetic Medicine,2017,34(4):478-484.
[14]屈政朋,杨玲.糖尿病白内障患者的临床手术治疗时机与治疗效果分析[J].中国当代医药,2018,25(8):110-112.
[15]陈前.糖尿病合并白内障与老年性白内障临床手术比较[J].昆明医科大学学报,2017,38(3):71-74.
[16]刘辉,孙静淳.前房注射不同剂量曲安奈德预防白内障术后炎症反应的临床分析[J].国外医学医学地理分册,2017,38(4):391-393.
[17]颜少彪,刘忠鑫.曲安奈德对白内障术后前葡萄膜炎患者的疗效及炎症因子的影响[J].中国老年学,2015(9):2532-2533.
[18]刘新书,王敏,赵潺,等.结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿的临床观察[J].中华眼科杂志,2015,51(10):734-738.
[19]Martin Roesel,Carsten Heinz.Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis[J].Graefes Arch Clin Exp Ophthalmo,2010,248(5):715-720.
[20]张岩,孔令普,马军艳,等.玻璃体切割联合曲安奈德染色处理白内障超声乳化术中后囊破裂的效果分析[J].中国实用眼科杂志,2015,33(10):828-830.
[21]Ahmadabadi HF,Mohammadi M,Beheshtnejad H,et al.Effect of intravitreal triamcinolone acetonide injection on central macular thickness in diabetic patients having phacoemulsification[J].J Cataract Refract Surg,2010,36(9)917-922.
[22]Gills JP,Gills P.Effect of intracameral triameinolone to control inflammation following cataract surgery[J].J Cataract Refract Surg,2005,31(8):1670-1671.
[23]Cleary CA,Lanigan B.Intracameral triamcinolone acetonide after pediatric cataract surgery[J].J Cataract Refract Surg,2010,36(10):1676-1681.