眼玻璃体内和球后注射曲安奈德治疗非动脉炎性前部缺血性视神经病变的临床研究

发布时间：2018-01-21 11:43

本文关键词： 非动脉炎性前部缺血性视神经病变曲安奈德玻璃体内注射曲安奈德球后注射曲安奈德常规治疗　出处：《河北医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：非动脉炎性前部缺血性视神经病变（nonarteritic anteriorischemic optic neuropathy，NAION）是一种由多致病因素引起的，以突然无痛性视力下降和/或特征性视野缺损、视盘的早期水肿和晚期萎缩为特点的常见视神经病变，在临床上尚无有效治疗方法以恢复患眼的视功能和防止对侧眼的累及。全身应用糖皮质激素对于急性期存在明显视盘水肿的NAION患眼具有快速消除视盘水肿，改善预后的一定治疗作用，但是副作用较为严重。本研究旨在探讨眼玻璃体内注射曲安奈德（intravitrealtriamcinolone acetonide injection，IVTA）、眼球后注射曲安奈德（retrobulbartriamcinolone acetonide injection，RBTA）和常规方法在治疗急性期存在明显视盘水肿的NAION中的作用，以期寻求针对急性期NAION的安全、有效的治疗方法。方法：最佳矫正视力≤0.4的NAION急性期患者38例38眼按照治疗前临床资料匹配原则被分成3组（低视力组）：低视力IVTA组12例12眼给予单次IVTA4mg/0.1ml+常规治疗，低视力RBTA组13例13眼给予单次RBTA20mg/0.5ml+常规治疗，低视力常规治疗组13例13眼给予单纯常规治疗。最佳矫正视力＞0.4的NAION急性期患者23例24眼按照治疗前临床资料匹配原则被分成2组（高视力组）：高视力RBTA组12例12眼给予单次RBTA20mg/0.5ml+常规治疗，高视力常规治疗组11例12眼给予单纯常规治疗。所有各组患眼的常规治疗方案相同。所有NAION患眼在开始治疗前以及治疗后的1、2、3、4、6、8、10、12周检查最佳矫正视力、眼压、视盘水肿的消退情况；治疗前以及治疗后4、8、12周进行视野检查；治疗前以及治疗后4、12周进行眼底荧光血管造影检查。结果：治疗后12周与治疗前比较，低视力各组NAION患眼的最佳矫正视力均显著提高，IVTA组（t=6.382，P=0.000）、RBTA组（t=6.620，P=0.000）、常规治疗组（t=2.636，P=0.022）；低视力IVTA组的视力提高显著优于RBTA组（P=0.016）和常规治疗组（P=0.000）；低视力RBTA组显著优于常规治疗组（P=0.035）；治疗后12周与治疗前比较，低视力IVTA组和RBTA组NAION患眼的视野平均敏感度显著改善，IVTA组（t=6.351，P=0.000）、RBTA组（t=3.111，P=0.009），而常规治疗组无显著改善（t=0.320，P=0.755）；低视力IVTA组的视野改善显著优于RBTA组（P=0.036）和常规治疗组（P=0.000），低视力RBTA组显著优于常规治疗组（P=0.042）；高视力RBTA组NAION患眼的视野平均敏感度显著改善（t=3.222，P=0.008），而常规治疗组无显著改善（t=2.117，P=0.058），高视力RBTA组与常规治疗组比较无显著性差异（t=1.710，P=0.101）。低视力IVTA组的视盘水肿平均在治疗后2.92±0.08周消退；没有患眼出现眼内炎症、玻璃体积血和激素性青光眼等并发症。视盘水肿平均消退时间，，低视力和高视力RBTA组分别在治疗后6.23±1.35周和5.72±1.30周，低视力和高视力常规治疗组分别在治疗后7.83±1.27周和7.50±1.23周。低视力IVTA组的视盘水肿平均消退时间显著短于RBTA组（P=0.000）和常规治疗组（P=0.000）；RBTA组显著短于常规治疗组（P=0.002）。高视力RBTA组的视盘水肿平均消退时间显著短于常规治疗组（t=2.416，P=0.024）。结论：IVTA和RBTA可以快速消除急性期NAION患眼的视盘水肿，提高视力和改善视野，联合常规方法治疗急性期NAION相对安全有效；IVTA比RBTA的治疗效果更佳。大样本、随机化、临床对照试验研究以进一步证实IVTA和RBTA临床应用的安全性和有效性值得开展。
[Abstract]:Objective: nonarteritic anterior ischemic optic neuropathy (nonarteritic anteriorischemic optic neuropathy, NAION) is a kind of induced by multiple pathogenic factors, in a sudden, painless visual loss and / or characteristics of visual field defect, optic disc edema early and late atrophy of common optic neuropathy, there is no effective treatment in clinic in order to recover the visual function of eye and prevent contralateral eye involvement. Systemic glucocorticoids can rapidly eliminate optic disc edema in the acute phase of obvious optic disc edema in NAION eyes, improve the prognosis of a certain therapeutic effect, but serious side effects. This study aims to investigate the intravitreal injection of Cu Ann Ned (intravitrealtriamcinolone acetonide injection, IVTA), retrobulbar injection (retrobulbartriamcinolone acetonide Cu Ann Ned injection, RBTA) and the conventional method in the treatment of In the acute phase, there is an obvious role in the NAION of the optic disc edema in order to find a safe and effective treatment for the acute phase of NAION.
Methods: the best corrected visual acuity is less than or equal to 0.4 NAION patients 38 eyes of 38 patients before treatment, clinical data were divided into 3 groups according to the matching principle (low vision group): Low Vision Group IVTA 12 cases 12 eyes with a single IVTA4mg/0.1ml+ treatment, low vision group RBTA 13 cases 13 eyes with a single RBTA20mg/ 0.5ml+ routine treatment. Low vision routine treatment group of 13 eyes of 13 patients treated with routine treatment. The best corrected visual acuity of more than 0.4 NAION patients with 23 eyes of 24 patients before treatment according to the clinical data of the matching principle were divided into 2 groups (high acuity group): high acuity group RBTA 12 cases 12 eyes with a single RBTA20mg/0.5ml+ treatment, the conventional treatment of high vision group of 11 eyes of 12 patients treated with routine treatment. All patients were routine treatment. All eyes of the same NAION eyes before the start of treatment and after treatment of 1,2,3,4,6,8,10,12 weeks to check the best corrected visual acuity, intraocular pressure, optic disc swelling subsided water Visual field examination before treatment and 4,8,12 weeks after treatment, and fundus fluorescein angiography before and after treatment, and 4,12 weeks after treatment.
Results: after 12 weeks of treatment compared with before treatment, group NAION had low vision eye best corrected visual acuity was significantly improved, IVTA group (t=6.382, P=0.000), RBTA group (t=6.620, P=0.000) and routine treatment group (t=2.636, P=0.022); low vision visual acuity of IVTA group increased significantly than group RBTA (P=0.016) and the conventional treatment group (P=0.000); low visual acuity of RBTA group was significantly better than conventional treatment group (P=0.035); 12 weeks after treatment compared with before treatment, low vision IVTA group and RBTA group NAION eyes vision mean sensitivity significantly improved, IVTA group (t=6.351, P= 0), RBTA group (t=3.111, P=0.009) however, no significant improvement in the conventional treatment group (t=0.320, P=0.755); low vision visual acuity of IVTA group improved significantly better than RBTA group (P=0.036) and conventional therapy group (P=0.000), low visual acuity of RBTA group was significantly better than conventional treatment group (P=0.042); high visual acuity of RBTA group NAION eyes vision mean sensitivity significantly improved (t=3.222, P=0.008), but no significant improvement in the conventional treatment group (t=2.117, P=0.058), there is no significant difference between the high visual acuity of RBTA group and routine treatment group (t=1.710, P=0.101). IVTA group of optic disc edema of low vision after treatment in average 2.92 + 0.08 weeks away; no eyes. The inflammation in the glass. The volume of blood and hormone glaucoma and other complications. The mean optic disc edema subsided time, low vision and high vision group RBTA respectively after treatment in 6.23 weeks + 1.35 and 5.72 + 1.30 weeks, low vision and high vision routine treatment group after treatment were 7.83 + 1.27 and 7.50 + weeks for 1.23 weeks. The edema of optic disc of low vision group IVTA the average extinction time was significantly shorter than that of RBTA group (P=0.000) and conventional therapy group (P=0.000); RBTA group was significantly shorter than the conventional treatment group (P=0.002). High papilloedema visual acuity of RBTA group was significantly shorter than the average extinction time of the conventional treatment group (t= 2.416, P=0.024).
Conclusion: IVTA and RBTA can quickly eliminate optic disc edema in acute stage NAION eyes, improve vision and improve vision, combined with conventional method in the treatment of acute NAION is effective and relatively safe; IVTA than RBTA better treatment effect. A large sample, randomized, controlled clinical trials to study further confirmed the efficacy and safety of IVTA and RBTA the clinical application should be carried out.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.6

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