目的：探讨标准操作程序在玻璃体腔内注药术护理中的应用效果。方法：选择2018年9至12月中山大学中山眼科中心眼底专科门诊504例玻璃体腔内注药术患者作为研究对象，对护理人力资源的整合、患者等待手术时间、患者和家属的满意度、医护人员满意度进行评价。结果：标准操作程序后明确护士岗位职责，护士操作水平和综合能力有效提升，患者手术等待时间由原来的预约2周缩短为2 d。患者和家属的满意度分别由92.0%和91.0%提高到98.5%和97.0%。医护人员满意度的评价由95%提到至98.4%。结论：玻璃体腔内注药术标准操作程序不仅提升了工作效率，更提升了患者和家属、医务人员的满意度，规范化的标准操作程序是玻璃体腔内注药的安全保障。
Objective: To investigate the effect of standard operation procedure in the intravitreal injection. Methods: A total of 504 patients visiting the fundus clinics of our hospital from September to December 2018 were selected in this study. The integration of nursing human resources, patient waiting time, patient and family satisfaction,and medical staff satisfaction were evaluated. Results: The nurses’ job responsibilities were clarified, and the nurses’ operation level and comprehensive ability were improved. The patients’ waiting time for surgery was shortened from 2 weeks to 2 days. Patient and family satisfaction increased from 92.0% and 91.0% to 98.5% and 97.0%, respectively. The evaluation of the satisfaction of medical staff was elevated from 95% to 98.4%.Conclusion: The standard operation procedure of intravitreal injection not only improves the work efficiency, but also significantly increases the satisfaction of patients and their families and medical staffs. Therefore, the standard operation procedure can guarantee the safety of intravitreal injection.
目的：分析玻璃体腔注射术后眼内炎的发生并总结原因，旨在进一步提高手术安全性。方法：回顾性分析中国人民解放军总医院第六医学中心2010年9月至2019年11月行玻璃体腔注射术的421例患者(973眼)的术后1 d、1周、1个月的随访资料。归纳注射药物种类、注射病因、患者全身病史，总结术后眼内炎的发生及治疗情况。结果：玻璃体腔注射术安全性高，但严重并发症眼内炎(0.41%)仍偶有发生。4例眼内炎患者中2例为Irvine-Gass综合征患者行曲安奈德玻璃体腔注射后，1例为视网膜中央静脉阻塞患者行曲安奈德玻璃体腔注射后，1例为中心性渗出性视网膜脉络膜病变患者行雷珠单抗玻璃体腔注射后。其中曲安奈德引起的眼内炎(1.99%)明显高于抗血管内皮生长因子(vascular endothelial growth factor，VEGF)药物引起的眼内炎(0.12%)。结论：严格按照操作指南操作，当针对高血压老年群体尤其是Irvine-Gass综合征患者玻璃体腔注射曲安奈德时尤其防范眼内炎的发生。
Objective: To analyze the incidence and causes of endophthalmitis after intravitreal injection and to further improve the safety of the surgery. Methods: The follow-up data of 973 eyes of 421 patients who received intravitreal injection in our hospital in the past 9 years at 1 day, 1 week and 1 month were retrospectively analyzed.The types of injected drugs, the cause of injection and systemic history were summarized, and the occurrence and treatment of postoperative endophthalmitis were summarized. Results: The intravitreal injections were safe.However, the severe complication of endophthalmitis (0.41%) occurred occasionally. Among these 4 patients with endophthalmitis, 2 patients were intravitreal injected triamcinolone acetonide because of Irvine-Gass syndrome;1 patient accepted intravitreal injection by Ranibizumab because of central retinal vein occlusion; 1 patient accepted intravitreal injection by Ranibizumab because of central exudative chorioretinopathy. The incidence of endophthalmitis (1.99%) after intravitreal injection of triamcinolone acetonide was higher than that of anti-vascular endothelial growth factor (VEGF) agents (0.12%). Conclusion: The clinical operating guideline of intravitreal injection should be followed strictly. Furthermore, the elderly people with hypertension diagnosed of Irvine-Gass syndrome have a higher risk of endophthalmitis after intravitreal injection of triamcinolone acetonide than others and should be paid more important attention.
目的：以光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)观察视网膜分支静脉阻塞(branch retinal vein occlusion，BRVO)抗血管内皮生长因子(vascular endothelial growth factor，VEGF)治疗前后的变化。方法：回顾性收集从2017年1月至2018年1 2月在汕头国际眼科中心的确诊为BRVO合并黄斑水肿的患者共3 1例3 2眼。患眼行玻璃体腔注射抗VEGF药物治疗，记录治疗前和治疗后1个月的最佳矫正视力(best corrected visual acuity，BCVA)，OCTA检查视网膜黄斑中心凹厚度(foveal macular thickness，FMT)、黄斑区血流密度。比较治疗前后各指标的变化。结果：治疗后BCVA较治疗前显著提高，差异有统计学意义(P<0.001)；FMT[(242.13±86.02) μm]较治疗前[(521.44±190.27) μm]明显下降，差异有统计学 意义(P<0.001)；中心凹浅层血流密度[(18.44±4.98)%]及中心凹旁浅层血流密度[(44.83±3.19)%]均较治疗前[(25.46±9.21)%，(46.06±5.25)%]相比明显下降，差异有统计学意义(P <0.001)。结论：玻璃体腔注射抗VEGF治疗BRVO合并黄斑水肿效果显著；OCTA能有效评价抗VEGF治疗BRVO合并黄斑水肿的临床疗效。
Objective: To evaluate the efficacy in patients with macular edema due to branch retinal vein occlusion (BRVO) treated with intravitreal anti-VEGF drug. Methods: In this retrospective study, 32 eyes of 31 patients with BRVO combined with macular edema at Joint Shantou international eye center of Shantou University and TheChinese University of Hong Kong during January 2017 to December 2018 were enrolled in this study. All the affected eyes received intravitreal anti-VEGF drug injections. BCVA (best corrective visual acuity) and optical coherence tomography angiography (OCTA) were performed before and one month after intravitreal anti-VEGF drug injections. Foveal macular thickness (FMT), macular blood flow density was measured in all eyes and compared. Results: The BCVA before therapy was (0.77±0.46) LogMAR and increased to (0.46±0.30) LogMAR in one month after therapy, which showed a statistical difference (P<0.001). The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density before therapy were (521.44±190.27) μm, (21.85±6.17)% and (46.29±2.70)%, respectively. The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density decreased to (242.13±86.02) μm, (18.40±5.18)% and (44.75±3.40)%, respectively. There was significant statistical difference for them (P<0.001). Conclusion: Intravitreal injection of anti-VEGF is effective in the treatment of BRVO combined with macular edema. OCTA can effectively evaluate the clinical efficacy of anti-VEGF in the treatment of BRVO combined with macular edema.
