發(fā)布時(shí)間：2018-01-21 11:43

  本文關(guān)鍵詞： 非動(dòng)脈炎性前部缺血性視神經(jīng)病變 曲安奈德 玻璃體內(nèi)注射曲安奈德 球后注射曲安奈德 常規(guī)治療　出處：《河北醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：非動(dòng)脈炎性前部缺血性視神經(jīng)病變（nonarteritic anteriorischemic optic neuropathy，NAION）是一種由多致病因素引起的，以突然無痛性視力下降和/或特征性視野缺損、視盤的早期水腫和晚期萎縮為特點(diǎn)的常見視神經(jīng)病變，在臨床上尚無有效治療方法以恢復(fù)患眼的視功能和防止對(duì)側(cè)眼的累及。全身應(yīng)用糖皮質(zhì)激素對(duì)于急性期存在明顯視盤水腫的NAION患眼具有快速消除視盤水腫，改善預(yù)后的一定治療作用，但是副作用較為嚴(yán)重。本研究旨在探討眼玻璃體內(nèi)注射曲安奈德（intravitrealtriamcinolone acetonide injection，IVTA）、眼球后注射曲安奈德（retrobulbartriamcinolone acetonide injection，RBTA）和常規(guī)方法在治療急性期存在明顯視盤水腫的NAION中的作用，以期尋求針對(duì)急性期NAION的安全、有效的治療方法。 方法：最佳矯正視力≤0.4的NAION急性期患者38例38眼按照治療前臨床資料匹配原則被分成3組（低視力組）：低視力IVTA組12例12眼給予單次IVTA4mg/0.1ml+常規(guī)治療，低視力RBTA組13例13眼給予單次RBTA20mg/0.5ml+常規(guī)治療，低視力常規(guī)治療組13例13眼給予單純常規(guī)治療。最佳矯正視力＞0.4的NAION急性期患者23例24眼按照治療前臨床資料匹配原則被分成2組（高視力組）：高視力RBTA組12例12眼給予單次RBTA20mg/0.5ml+常規(guī)治療，高視力常規(guī)治療組11例12眼給予單純常規(guī)治療。所有各組患眼的常規(guī)治療方案相同。所有NAION患眼在開始治療前以及治療后的1、2、3、4、6、8、10、12周檢查最佳矯正視力、眼壓、視盤水腫的消退情況；治療前以及治療后4、8、12周進(jìn)行視野檢查；治療前以及治療后4、12周進(jìn)行眼底熒光血管造影檢查。 結(jié)果：治療后12周與治療前比較，低視力各組NAION患眼的最佳矯正視力均顯著提高，IVTA組（t=6.382，P=0.000）、RBTA組（t=6.620，P=0.000）、常規(guī)治療組（t=2.636，P=0.022）；低視力IVTA組的視力提高顯著優(yōu)于RBTA組（P=0.016）和常規(guī)治療組（P=0.000）；低視力RBTA組顯著優(yōu)于常規(guī)治療組（P=0.035）；治療后12周與治療前比較，低視力IVTA組和RBTA組NAION患眼的視野平均敏感度顯著改善，IVTA組（t=6.351，P=0.000）、RBTA組（t=3.111，P=0.009），而常規(guī)治療組無顯著改善（t=0.320，P=0.755）；低視力IVTA組的視野改善顯著優(yōu)于RBTA組（P=0.036）和常規(guī)治療組（P=0.000），低視力RBTA組顯著優(yōu)于常規(guī)治療組（P=0.042）；高視力RBTA組NAION患眼的視野平均敏感度顯著改善（t=3.222，P=0.008），而常規(guī)治療組無顯著改善（t=2.117，P=0.058），高視力RBTA組與常規(guī)治療組比較無顯著性差異（t=1.710，P=0.101）。低視力IVTA組的視盤水腫平均在治療后2.92±0.08周消退；沒有患眼出現(xiàn)眼內(nèi)炎癥、玻璃體積血和激素性青光眼等并發(fā)癥。視盤水腫平均消退時(shí)間，，低視力和高視力RBTA組分別在治療后6.23±1.35周和5.72±1.30周，低視力和高視力常規(guī)治療組分別在治療后7.83±1.27周和7.50±1.23周。低視力IVTA組的視盤水腫平均消退時(shí)間顯著短于RBTA組（P=0.000）和常規(guī)治療組（P=0.000）；RBTA組顯著短于常規(guī)治療組（P=0.002）。高視力RBTA組的視盤水腫平均消退時(shí)間顯著短于常規(guī)治療組（t=2.416，P=0.024）。 結(jié)論：IVTA和RBTA可以快速消除急性期NAION患眼的視盤水腫，提高視力和改善視野，聯(lián)合常規(guī)方法治療急性期NAION相對(duì)安全有效；IVTA比RBTA的治療效果更佳。大樣本、隨機(jī)化、臨床對(duì)照試驗(yàn)研究以進(jìn)一步證實(shí)IVTA和RBTA臨床應(yīng)用的安全性和有效性值得開展。
[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.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R774.6

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