| Objective:To explore the clinical efficacy and safety of Retrobulbar injection of dexamethasone and anisodamine combined with retinal laser photocoagulation in the treatment of diabetic macular edema(DME).Methods:A total of 48 patients(57 eyes)diagnosed with DME in our hospital from August 2018 to March 2020 were selected and randomly divided into an experimental group(28 cases,35eyes)and a control group(20 cases,22 eyes).The experimental group was treated with intravitreal injection of dexamethasone and anisodamine combined with retinal laser photocoagulation,while the control group was treated with retinal laser photocoagulation alone.To examine the best corrected visual acuity(BCVA),macular foveal thickness(CMT),intraocular pressure and related complications such as retrobulbar hemorrhage,retinal detachment,endophthalmitis,new cataracts and exacerbation of cataracts before and 7 days,14 days,1 month and 3 months after treatment.To examine and record the fluorescein fundus angiography(FFA)of the patient before and 1 month and 3months after treatment.Results:(1)Sex ratio composition:In this study,there were 19male patients(24 eyes,68.6%)and 11 females(11 eyes,31.8%)in the test group;11 males(15 eyes,68.2%)and 7 females(7 eyes,31.8%)in the control group.There was no significant difference in sex ratio between the test group and the control group(P>0.05).(2)Diabetes history:In this study,the average history of diabetes was(17.1±5.4)years in the trial group and(17.7±4.9)years in the control group.There was no significant difference in diabetes history between the test group and the control group(P>0.05).(3)The proportion of high-risk eyes:In this study,12eyes in the test group had high-risk eyes,accounting for34.3%of the eyes in the test group,and 8 eyes in the control group,accounting for 36.4%of the eyes in the control group.There was no significant difference in the proportion of high-risk eyes between the two groups(P>0.05).(4)BCVA:At 7 days,14 days,1 month and 3 months after treatment,the BCVA of the experimental group was significantly higher than that of the control group(P>005),and the BCVA of the experimental group was higher than that of the control group at 7 days,14 days,1 month and 3months after treatment(P>0 05).The peak value of BCVA in the experimental group appeared earlier than that in the control group(P>0 05).Three months after treatment,the visual acuity of 30 eyes in the test group was significantly improved(10 eyes at high risk),1 eye was slightly improved(0 eyes at high risk),and 4 eyes were not improved(2 eyes at high risk).In the control group,the visual acuity was improved in 11 eyes(2 eyes in high risk eyes),slightly improved in 2 eyes(0 eyes in high risk eyes),no improvement in 6 eyes(5 eyes in high risk eyes),and decreased in 3 eyes(1 eye in high risk eyes).(5)CMT:At 7 days,14 days,1 month and 3 months after treatment,the CMT of the experimental group was significantly lower than that of the control group(P<005),and the CMT of the experimental group was lower than that of the control group at 7 days,14 days,1 month and 3months after treatment(P>0 05).The low value of CMT in the experimental group appeared earlier than that in the control group.Three months after treatment,macular edema recurred in 2 eyes in the test group(0 eyes in high risk eyes),persistent macular edema in 2 eyes(2 eyes in high risk eyes),recurrent macular edema in 4 eyes in the control group(1 eye in high risk eyes),persistent macular edema in4 eyes(4 eyes in high risk eyes),and aggravation of macular edema in 1 eye(1 eye in high risk eyes).(6)Curative effect:One month after treatment:in the experimental group,the symptoms were significantly relieved in 19 eyes(54.3%),partially relieved in 14 eyes(40.0%),and not relieved in 2 eyes(5.7%).In the control group,the symptoms were significantly relieved in 4 eyes(18.2%),partially relieved in 13 eyes(59.1%)and not relieved in 5eyes(22.7%).There was no significant difference between the two groups(χ~2=2.22,P>0.05).The effective rate of the test group was 94.3%,and that of the control group was77.3%.The effective rate of the test group was higher than that of the control group.Three months after treatment:the symptoms were significantly relieved in 14 eyes(40.0%),partially relieved in 17 eyes(48.6%)and not relieved in 4eyes(11.4%)in the experimental group.In the control group,the symptoms were significantly relieved in 1 eye(4.5%)and partially relieved in 12 eyes(54.5%).Symptoms were not relieved in 6 eyes(27.8%)and aggravated in 3 eyes(13.6%).There was significant difference in curative effect between the two groups(χ~2=6.669,P<0.05).The effective rate of the experimental group was 88.6%.The effective rate of the control group was 59.1%,and that of the test group was higher than that of the control group.Three months after treatment,the symptoms of 6 eyes(83.3%)in the test group were relieved,2 eyes(16.7%)were not relieved,2 eyes(25.0%)in the control group were relieved,5 eyes(62.5%)were not relieved,and 1 eye(12.5%)was aggravated.The therapeutic effectiveness of the test group on high-risk eyes was significantly higher than that of the control group,and the difference was statistically significant(χ~2=4.592,P<0.05).(7)IOP:The IOP of the experimental group and the control group was within the normal range before treatment(10～21mm Hg),but there was no significant difference between the experimental group and the control group at 7 days,14days,1 month and 3 months after treatment(P>0.05).There was no significant difference in intraocular pressure between the experimental group and the control group at 7 days,14days,1 month and 3 months after treatment(P>0.05).During the follow-up period,transient IOP fluctuations occurred in some eyes,including 2 eyes in the test group and 0 eyes in the control group.The IOP of the 2 eyes was within 25mm Hg.After 1 hour,the IOP returned to the normal level,and the IOP was still normal after 1 day.(8)Other complications:Subconjunctival hemorrhage occurred in 2 eyes in the test group and 0 eyes in the control group during the follow-up period,and there was no significant difference between the two groups(χ~2=1.996,P>0.05).There were no serious complications such as Retrobulbar hemorrhage,posterior subcapsular cataract,endophthalmitis,retinal detachment and glaucoma.Conclusion:(1)Retrobulbar injection of dexamethasone and anisodamine combined with retinal laser photocoagulation in the treatment of DME is better than that of laser photocoagulation alone,and the course of disease is shorter.(2)Retrobulbar injection of mixture of dexamethasone and anisodamine combined with retinal laser photocoagulation is more effective than laser photocoagulation alone in the treatment of high-risk DME.(3)Retrobulbar injection of mixture of dexamethasone and anisodamine combined with retinal laser photocoagulation is a safe and effective method for the treatment of DME. |
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