Macular Abnormalities and Treatment after Clear Cornea Phacoemulsification-An Optical Coherence Tomography Study

以光學同調斷層掃描研究白內障乳化術後黃斑部水腫及其它黃斑部病變之盛行率及治療成效

陳品芳(Pin-Fang Chen) ； 陳偉勵(Wei-Li Chen) ； 楊長豪(Chang-Hao Yang) ； 楊中美(Chung-May Yang)

《中華民國眼科醫學會雜誌》 48卷2期 (2009/06) Pp. 205-212

https://doi.org/10.30048/ACTASOS.200906.0014

摘要

目的：分析本院接受白內障乳化術患者併發囊狀黃斑部水腫及發現其它既存性黃斑部病變之盛行率及治療狀況。此研究運用眼部光學同調段斷層掃瞄(OCT)作為診斷及紀錄眼底異常之工具
方法：收集自2005年八月迄2006年四月間七十七例常規性白內障乳化術併人工水晶體植入患眼（共六十三位患者），進行前瞻性研究分析。所有患者安排於術後第一、三、六週進行OCT造影，若發現病患有囊狀黃斑部水腫則施予triamcinolone acetonide懸浮液40mg/1mL眼球筋膜下注射並持續每週以OCT追蹤，若水腫超過兩週未改善，則重覆施以藥物注射治療。
結果：以OCT造影顯示術後六週內囊狀黃斑部水腫盛行率為5.2 %（四例患眼），其中兩例於第一週發現、一例於第三週發現、另一例於第六週發現。施予triamcinolone眼球筋膜下注射後，其中二例於注射二週後復原，一例於三週後，另一例則於六週後康復。此外，在本研究中亦發現7.8 % （六例患眼）既存性其它型黃斑部病變，如脈胳膜新生血管、高度近視相關之黃斑部病變、黃斑部層板裂孔等。
結論：本研究顯示5.2%進行超音波乳化術及人工水晶體植入患眼術後六週內發生囊狀黃斑部水腫，而施予Triamcinolone眼球筋膜下注射可達良好療效。然患者可能因各類既存性黃斑病變使術後視力未達頂期。依此研究之經驗，利用OCT造影評估白內障術後黃斑部病變之治療效果，乃一安全、可靠之診斷工具。

並列摘要

Purpose: To determine the occurrence rate and prognosis of cystoid macular edema (CME) and to examine other forms of maculopathy after clear corneal phacoemulsification.
Methods: A prospective study of 77 cases (63 patients) was conducted using optical coherence tomography (OCT) to document the macular abnormal-lities after clear corneal phacoemulsification and intraocular lens (IOL) implant-tation done from August, 2005 to April, 2006 in NTUH. OCT was routinely performed in the 1st, 3rd, and 6th week postoperatively (post-OP); any macular abnormality was recorded. Patients diagnosed as CME received injection of posterior subtenon triamcinolone acetonide (PSTA) 40mg in 1.0ml suspension. Repeated injection was done if weekly OCT examination showed persistent edema longer than 2 weeks.
Results: The occurrence rate of postoperative CME in 6 weeks was 5.2% (4 eyes) in our study. Two were detected in the 1st week and the other two in the 3rd week, and 6th week postoperatively. After PSTA, 2 eyes had CME resolved in two weeks, one in three weeks, and one in six weeks. Other forms of maculopathy including CNVM, myopic maculopathy and lamellar hole were noted in 7.8% (6 eyes)..
Conclusion: About 5% of the eyes developed OCT-confirmed CME within 6 weeks after phacoemulsification and IOL implantation in the study. Subtenon injection of triamcinolone was an effective treatment. Other forms of maculopathy may have existed before cataract surgery. OCT provides a safe and effective tool in the diagnosis and follow-up of maculopathies after cataract surgery.

並列關鍵字

cystoid macular edema ； optical coherence tomography ； phacoemulsification