| In the recent years research on treatment of macular edema by intravitreal triamcinolone acetonid(eTA) become a hotspot. Many research conclude TA can fadeaway edema and improve the visual acuity , whereas along with the follow-up, the long-term efficacy is not very optimistic, and macular edema recur for some patients after a good efficacy. This research is to observe clinical effect of intravitreal triamcinone combined with retrobulbar injection of urokinase for the treatment of macular edema due to retinal vein occlusion, and investigate whether the way plays a active role in consolidating the therapeutic effects of intravitreal triamcinone and reduce the recurrence rate of macular edema, to analyze fundus fluorescence angiography of recrudescent patients and search the reason for the recrudescent of ME. Thereby, we can try to prevent the recurrence through clinical intervention.Methods: the authors conducted a retrospective study of patients with macular edema due to RVO who were diagnosed by indirect ophthalmoscope, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) etc. 66 eyes of 66 patients were divided into the control group (36 eyes), accepting simply intravitreal triamcinone,and treatment group (30 eyes), accepting intravitreal triamcinone combined with retrobulbar injection of urokinase. Main Outcome Measures: best corrected visual acuity (BCVA), intraocular pressure, state of ocular anterior segment and fundus, foveal thickening with OCT, FFA.Efficacy measure: transform the BCVA into logarithm of the minimum angle of resolution(LogMAR).According as the change of visual acuity devide thetherapeutic effects into efficacy(visual acuity increase≥2 lines ) and inefficacy (visual acuity increase <2 lines or decline);For the eyes which retinal thickness at macular area before surgery are higher than 400um, if it's OCT value after surgery is at least 2/3 of that one before surgery,the treatment is effective. For the eyes which retinal thickness at macular area before surgery are lower than 400um, Efficacy measures mainly depend on foveal shape,that is ,if foveal shape improved and OCT value decrease we also think the treatment is effective. If foveal shape deteriorated even macular hole occure the treatment is noneffective.Recurrence measure:if the treatment is effective by the best OCT value after surgery. Subsequently macular shape aggravate,OCT value increase and visual acuity decline, we think macular edema recur.Results: (1)At the 3-month ,by the way of the BCVA, effective rate of the control group was 83.3%,recurrence rate was 3.2%, effective rate of the treatment group was 86.7%,recurrence rate was 3.7%.There was no significant difference in effective rate and recurrence rate between the two groups (p>0.05). By the way of OCT, effective rate of the control group was 86.1%, recurrence rate was 3.1%. Effective rate of the treatment group was 90.0%, recurrence rate was 3.6%.There was also no significant difference in effective rate and recurrence rate between the two groups (p>0.05) ;(2) At the 6-month ,by the way of BCVA, effective rate of the control group was 61.1%,recurrence rate was 29.0%. Effective rate was of the treatment group 83.3%,recurrence rate was 7.4%.There was significant difference in effective rateand recurrence rate between the two groups (p<0.05) .By the way of OCT, effective rate of the control group was 63.9%,recurrence rate was 28.1%. Effective rate of the treatment group was 86.7%, recurrence rate was 7.1%.There was also significant difference in effective rate and recurrence rate between the two groups (p<0.05) .(3)Between the 2- and 6-month after surgery, 11 cases developed a recurrence of macular edema. before surgery 6 of them are non- ischemic RVO,5 of them are ischemic RVO .but after recurrence for the ischemic RVO fluoresce leakage aggravated,non-irrigated areas enlarged; for the non ischemic RVO 3 of them transform to ischemic RVO.(4) Intraocular pressure increased in 28 cases, 1 case occured a corticosteroid-induced glaucoma; 9 cases experienced an aqueous flare; 4 cases occured residual vehicles, 1 case occured retrobulbar hemorrhage.Conclusion: (1)The therapeutic effect of intravitreal triamcinone combined with retrobulbar injection of urokinase is better than the one of simply intravitreal triamcinone. But the former's recurrence rate is lower than the latter's.(2)Retrobulbar injection of urokinase can improve the retinal circulation, therefore consolidate the therapeutic effect of intravitreal triamcinone to macular edema. Reduce the recurrence rate of macular edema.(3)Recurrence of ME is close related to the blood circulation state of retina.that is, the transformation from non-ischemic RVO to ischemic RVO is probably the dangerous factor in the recurrence of ME .(4)Prevention and leng-term observation of complications oughtn't to beignored. |
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