糖尿病黄斑浮腫に対する追加治療としてのトリアムシノロン硝子体内注射の短期治療成績

Short-term outcome of intravitreal injection of triamcinolone as additional treatment for diabetic macular edema

要約　目的：糖尿病黄斑浮腫（DME）に対するトリアムシノロンアセトニド（4mg/0.1ml）硝子体内注射（IVTA）の効果報告は少ない。今回筆者らはDMEに対してIVTAを行い，短期治療成績について検討した。

方法と対象：DMEに対してTA（20mg/0.5ml）テノン囊下投与後もDMEが改善せず，IVTAを行った14例21眼〔平均年齢63.2±7.8歳，男性10例，女性4例，汎網膜光凝固術（PRR）全例施行済み〕。方法として，IVTA前とIVTA施行1か月後の視力とCRTを比較検討し，また副作用の有無を検討した。

結果：IVTA前のlogMAR視力は平均0.62±0.37，中心窩網膜厚は平均584±228μmであった。IVTA施行1か月後のlogMAR視力は平均0.50±0.39で有意な差はなかったが，中心窩網膜厚は平均293±168μm（p＝0.01）で有意に改善した。眼圧上昇は2例あったが，点眼でのコントロールが可能であった。白内障の進行はなかった。

結論：DMEに対してIVTAを施行した症例の短期成績は良好であったが視力の改善に有意差はなかった。

Abstract　Purpose: To present a report on short-term outcome of intravitreal injection of triamcinolone as additional treatment for diabetic macular edema.

Cases and Method: This study was made on 21 eyes of 14 cases with diabetic macular edema. The series comprised 10 males and 4 females. The age ranged from 45 to 77 years, average 63 years. Five eyes were aphakic and 16 were aphakic. Seven eyes had history of previous vitrectomy. Panreetinal photocoagulation had been performed in all the eyes. Subtenon injection of triamcinolone had proved ineffective in all the eyes. Cases were followed up for one month after intravitreal triamcinolone. Visual acuity was evaluated as logMAR.

Results: Visual acuity averaged 0.62±0.37 before treatment and 0.50±0.39 one month after treatment. The difference was not significant. Central retinal thickness averaged 584±228 μm before treatment and 293±168 μm one month after treatment. The difference was significant（p＝0.01）. Intraocular pressure rose in 2 eyes but was controlled by topical treatment. There was no progression of cataract.

Conclusion: Intravitreal injection of triamcinolone was followed by decrease in foveal retinal thickness and no change in visual acuity when evaluated one month after treatment.