曲安奈德后Tenon囊下注射治疗Vogt-小柳-原田氏病黄斑部浆液性脱离

Injection of Triamcinolone Acetonide (TA) under Tenon’s on the Macular Serous Retinal Detachment of Vogt-Koyanagi-Harada (VKH) Disease

摘要: 目的：观察曲安奈德球后Tenon囊下注射联合全身糖皮质激素治疗Vogt-小柳-原田氏病的临床疗效。方法：经眼底荧光血管造影和频域OCT确诊的Vogt-小柳-原田氏病18例34眼，病变急性期给予行大剂量糖皮质激素冲击治疗，激素减量期间结合曲安奈德后Tenon囊下注射，时间为每月1次，20 mg/0.5 ml次，共3次。所有患者在治疗前及治疗后检查裸眼视力、最佳矫正视力、眼前节检查、眼底彩照和频域光相干断层扫描，并使用SPSS17.0 对数据进行统计学分析。结果：治疗后所有患者视力均有不同程度提高。治疗前所有患者造影出现多数针尖状高荧光点和多湖状高荧光斑，治疗6个月，32眼荧光素眼底血管造影未见异常，其平均高度为378 ± 234 um。治疗后其平均高度为153 ± 67 um，比治疗前平均下降59.5%。两组比较差异有显著统计学意义(p < 0.01)。结论：曲安奈德后Tenon’s注射治疗Vogt-小柳-原田病，能够明显改善黄斑区的浆液性视网膜脱离并能减少疾病的复发。

Abstract: Objectives: To observe the clinic effect of Vogt-Koyanagi- Harada (VKH) Disease by injecting triamcinolone acetonide (TA) under Tenon’s. Methods: 34 eyes of 18 consecutive patients diagnosed with acute Vogt-Koyanagi-Harada Disease by FFA and OCT. All the patients were given pmethylprednisolone combined with triamcinolone acetonide (TA) injection under Tenon’s, and the frequency is once a month, 20 mg/0.5ml every time, and it will be done totally three times. All the patients were performed no-corrected visual activity, best corrected visual activity, slit- lamp check, fundus photograph and spectral-domain optical coherence tomography (OCT) at the initial visit and 6 months after steroid treatment. All the data were analyzed by SPSS 17.0. Results: After the treatment, all the patients’ VA improved. At the initial, all eyes showed the most hyperfluorescence pinpoints and the leakage of fluorescence pooling. After treatment for 6 months, the FFA of 32 patients showed normal. The thickness of fovea was (378 ± 234) μm before treatment and (153 ± 67) μm after treatment, which decreased by 59.5% on average; there was significantly difference between the two groups (p < 0.01). Conclusion: For VHK disease, the treatment of pmethylprednisolone combined with TA injection under Tenon’s can improve the macular serous retinal detachment and reduce the relapse of the disease.