玻璃体内药物注.pptVIP

* * 玻璃体内药物注射 Intravitreous injection: The route of retinal pharmacotherapies History of IVT Injection 1911 first published study:air tamponade RD 1940 IVT injection of SM, penicilline endo-PTM 1987 IVT injection of Cytovine-CMV retinitis 1998 Vitravene. USA,FDA firstdrug for IVT 2004 15 000 IVTinjectionpast 10yrs(Retina2005,10) Guideline For care and prophylaxis before injection A. Disorders should be management beforeIVT (1) glaucoma (2) allergies to povidone iodine (3) active external infection (4) eyelid abnormalities B. Gloves and draping Prophylactic antibiotics (1) using preinjection topical antibiotics for 3 d. (2) avoiding :to pressure the eyelids,lid maegins, the adnexa (3) preinjection globe softening For peri-injection management A. Pupillary dilation B. Topical aneasthetic C. Subconjuntival aneasthetic D. Povidone iodine(drop or flush) E. Speculum Site of injection the pars plana in the inferotemporal quadrant (1) pseudophakic,3.5 mm (2) phakic eye , 4.0 mm Needle size =27 G. needle, 1.27-1.57 cm length (at least 6mm toward the center of the eye) Injection moderate slow injection . Carefully removed from the eye . to prevent reflux. For post-injection management A. Postinjection antibiotics B. Intraocular pressure monitor IOP (transient high IOP, CRAO, no LP) C. Postinjection reperfusion of the optic nerve: verify------optic nerve CRA. vitreous(hemorrhage) retina D.Endophthalmitis(imflamtion?) (infection? 0.6-1.4%) D.Endophthalmitis(imflamtion?) 术前OCT图像－－黄斑视网膜增厚达697μm 术前眼底彩照 术后OCT图像－－黄斑视网膜厚度为354μm *