[1]杨红伟,侯习武,关微,等.地塞米松玻璃体内植入剂在非感染性葡萄膜炎继发黄斑水肿患者治疗中的作用[J].眼科新进展,2023,43(6):484-486.[doi:10.13389/j.cnki.rao.2023.0098]
　YANG Hongwei,HOU Xiwu,GUAN Wei,et al.Role of dexamethasone intravitreal implants in the treatment of macular edema secondary to non-infectious uveitis[J].Recent Advances in Ophthalmology,2023,43(6):484-486.[doi:10.13389/j.cnki.rao.2023.0098]
点击复制

地塞米松玻璃体内植入剂在非感染性葡萄膜炎继发黄斑水肿患者治疗中的作用/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
43卷
期数:
2023年6期
页码:
484-486
栏目:
应用研究
出版日期:
2023-06-05

文章信息/Info

Title:
Role of dexamethasone intravitreal implants in the treatment of macular edema secondary to non-infectious uveitis
作者:
杨红伟; 侯习武; 关微; 刘德成
450016　河南省郑州市，郑州市第七人民医院眼科（杨红伟，关微，刘德成）；450052　河南省郑州市，郑州大学第一附属医院眼科（侯习武）
Author(s):
YANG Hongwei1; HOU Xiwu2; GUAN Wei1; LIU Decheng1
1.Department of Ophthalmology，the Seventh People’s Hospital of Zhengzhou，Zhengzhou 450016，Henan Province,China
2.Department of Ophthalmology，the First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052， Henan Province,China
关键词:
地塞米松玻璃体内植入剂; 葡萄膜炎; 黄斑水肿; 玻璃体内注射; 药物释放系统
Keywords:
dexamethasone intravitreal implant;  uveitis;  macular edema;  intravitreal injection;  drug release system
分类号:
R773
DOI:
10.13389/j.cnki.rao.2023.0098
文献标志码:
A
摘要:
目的　观察地塞米松玻璃体内植入剂在治疗非感染性葡萄膜炎继发黄斑水肿中的安全性和临床疗效。
方法　回顾性分析我院2019年12月至2021年12月临床确诊的非感染性葡萄膜炎继发黄斑水肿患者30例（30眼），给予玻璃体内注射地塞米松玻璃体内植入剂治疗。所有患眼均行最佳矫正视力(BCVA)及眼压测量，并采用OCT测量黄斑中心视网膜厚度(CMT)。术后随访6个月，所有患者均于术前，术后1个月、3个月及6个月重复检测并比较BCVA、CMT。随访期间观察患者眼压变化，监测白内障进展、结膜下出血等眼部不良反应。
结果　患者术前及术后1个月、3个月及6个月BCVA(logMAR)分别为0.74±0.37、0.47±0.29、0.28±0.14、0.37±0.17。患者术前，术后1个月、3个月及6个月CMT分别为(372.12± 99.42)μm、(298.14±82.44)μm、(278.45±62.43)μm、(289.31±56.34)μm。患者各时间点BCVA、CMT差异均有统计学意义（均为P<0.05)。与术前相比，患者术后1个月、3个月及6个月BCVA和CMT差异均有统计学意义（均为P<0.05）。术后各时间点两两比较结果显示，患者BCVA和CMT差异均无统计学意义（均为P>0.05)。随访期间有6例患者出现眼压升高（≥25 mmHg，1 kPa=7.5 mmHg），经局部降眼压药物应用后降至正常水平。4例患者出现白内障进展，均无需手术治疗。
结论　玻璃体内注射地塞米松玻璃体内植入剂能够提高患者视力及降低CMT，有效治疗非感染性葡萄膜炎继发黄斑水肿。
Abstract:
Objective　To investigate the safety and clinical efficacy of dexamethasone intravitreal implant in the treatment of macular edema secondary to non-infectious uveitis.
Methods　In this retrospective study, 30 patients (30 eyes) with clinically confirmed macular edema secondary to non-infectious uveitis in our hospital from December 2019 to December 2021 were treated with intravitreal injection of dexamethasone implants.The best corrected visual acuity (BCVA) and intraocular pressure (IOP) of all affected eyes were measured. The central macular thickness (CMT) was evaluated by optical coherence tomography.During the follow-up 6 months, all patients received repeated measurements of BCVA and CMT at 1, 3 and 6 months after surgery. In addition, IOP changes, cataract progression, and subconjunctival hemorrhage were monitored.
Results　The BCVA (logMAR) before and 1, 3 and 6 months after surgery was 0.74±0.37, 0.47±0.29, 0.28±0.14, and 0.37±0.17, respectively. The CMT before and 1, 3 and 6 months after surgery was (372.12±99.42) μm, (298.14±82.44) μm, (278.45±62.43) μm, and (289.31±56.34) μm, respectively. Significant differences were found in BCVA and CMT at different time points (P<0.05). Compared with the preoperative conditions, the BCVA and CMT of all eyes significantly changed at 1, 3 and 6 months after surgery (all P<0.05). There was no significant difference in the pairwise comparisons of BCVA and CMT at various time points after surgery (all P>0.05).During the follow-up periods, IOP elevated (≥25 mmHg, 1 kPa=7.5 mmHg) in 6 patients, but decreased to the normal level after local IOP-lowering medication. Cataract progression occurred in 4 patients, none of which required surgery.
Conclusion　Dexamethasone intravitreal implants can improve visual acuity and reduce CMT; thus, it is an effective approach to treat macular edema secondary to non-infectious uveitis.

参考文献/References:

［1］　FARDEAU C,CHAMPION E,MASSAMBA N,LEHOANG P.Uveitic macular edema［J］.Eye,2016,30(10):1277-1292.
［2］　KARIM R,SYKAKIS E,LIGHTMAN S,FRASER-BELL S.Interventions for the treatment of uveitic macular edema:a systematic review and meta-analysis［J］.Clin Ophthalmol，2013,7:1109-1144.
［3］　PARODI M B,IARCONO P,PETRUZZI G,PARRAVANO M,VARANO M,BANDELLO F.Dexamethasone implant for macular edema secondary to ischemic retinal vein occlusions［J］.Retina,2015,35(7):1387-1392.
［4］　白小芳,赵芃芃,秦梅,卢凤丽,张琴,李思园,等.雷珠单抗联合Ozurdex治疗视网膜分支静脉阻塞继发黄斑水肿的疗效观察［J］.眼科新进展,2022,42(5):394-398.
BAI X F,ZHAO F F,QIN M,LU F L,ZHANG Q,LI S Y,et al.Clinical effect of Ranibizumab combined with Ozurdex in the treatment of macular edema secondary to branch retinal vein occlusion［J］.Rec Adv Ophthalmol,2022,42(5):394-398.
［5］　RITTIPHAIROJ T,MIR T A,LI T,VIRGILI G.Intravitreal steroids for macular edema in diabetes［J］.Cochrane Database Syst Rev,2020,11(11):CD005656.
［6］　LASAVE A F,SCHLAEN A,ZEBALLOS D G,DIAZ-LLOPIS M,COUTO C,EL-HAIG W M,et al.Twenty-four months follow-up of intravitreal bevacizumab injection versus intravitreal triamcinolone acetonide injection for the management of persistent non-infectious uveitic cystoid macular edema［J］.Ocul Immunol Inflamm,2019,27(2):294-302.
［7］　李筱荣,周怀蔚.重视黄斑水肿的病因、治疗及预防［J］.眼科新进展,2019,39(7):601-605.
LI X R,ZHOU H W.Special attention to the cause,treatment and prevention of macular edema［J］.Rec Adv Ophthalmol,2019,39(7):601-605.
［8］　STOREY P P,OBEID A,PANCHOLY M,GOODMAN J,BORKAR D,SU D,et al.Ocular hypertension after intravitreal injection of 2 mg triamcinolone acetonide［J］.Retina,2020,40(1):75-79.
［9］　MORRISON V L,KOZAK I,LABREE L D,AZEN S P,KAYICIOGLU O O,FREEMAN W R.Intravitreal triamcinolone acetonide for the treatment of immune recovery uveitis macular edema［J］.Ophthalmology,2007,114(2):334-339.
［10］　GANAPATHY P S,LOWDER C Y,AREPALLI S,BAYNES K,LI M,BENA J,et al.Treatment duration and side effect profile of long-term use of intravitreal preservative-free triamcinolone acetonide in uveitis［J］.Am J Ophthalmol,2018,194:63-71.
［11］　LONDON N J,CHIANG A,HALLER J A.The dexamethasone drug delivery system:indications and evidence［J］.Adv Ther,2011,28(5):351-366.
［12］　MISHRA S K,GUPTA A,PATYAL S,KUMAR S,RAJI K,SINGH A,et al.Intravitreal dexamethasone implant versus triamcinolone acetonide for macular oedema of central retinal vein occlusion:quantifying efficacy and safety［J］.Int J Retina Vitreous,2018,26(4):13.
［13］　冼志林,梁琦晨,袁洋行,黄金飞,袁珂鳗,翁宏武,等.地塞米松玻璃体内植入剂 Ozurdex 治疗视网膜静脉阻塞继发黄斑水肿的研究进展［J］.眼科新进展,2020,40(3):296-300.
XIAN Z L,LIANG Q C,YUAN Y H,HUANG J F,YUAN K M,WENG H W,et al.Research advances on dexamethasone intravitreal implant Ozurdex for treat-ment of macular edema secondary to retinal vein occlusion［J］.Rec Adv Ophthalmol,2020,40(3):296-300.
［14］　LOWDER C,BELFORT R J R,LIGHTMAN S,FOSTER C S,ROBINSON M R,SCHIFFMAN R M,et al.Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis［J］.Arch Ophthalmol,2011,129(5):545-553.
［15］　YALCINBAYIR O,CALISKAN E,UCAN GUNDUZ G,GELISKEN O,KADERLI B,YUCEL A A.Efficacy of Dexamethasone implants in uveitic macular edema in cases with behet disease［J］.Ophthalmologica,2019,241(4):190-194.
［16］　叶娅,宋艳萍.地塞米松玻璃体腔植入剂治疗活动性非感染性葡萄膜炎黄斑水肿的疗效观察［J］.中华眼底病杂志,2020,36(9):691-696.
YE Y,SONG Y P.Clinical efficacy of dexamethasone intravitreal Implant in the treatment of active non-infectious uveitis with macular edema［J］.Chin J Ocul Fundus Dis,2020,36(9):691-696.
［17］　NOBRE-CARDOSO J,CHAMPION E,DARUGAR A,FEL A,LEHOANG P,BODAGHI B.Treatment of non-infectious uveitic macular edema with the intravitreal dexamethasone implant［J］.Ocul Immunol Inflamm,2017,25(4):447-454.
［18］　ZARRAZ-VENTURA J,CARRENO E,JOHNSTON R L,MOHAMMED Q,ROSS A H,BARKER C,et al.Multicenter study of intravitreal dexamethasone implant in noninfectious uveitis:indications,outcomes,and reinjection frequency［J］.Am J Ophthalmol,2014,158(6):1136-1145.e5.
［19］　TOMKINS-NETZER O,TAYLOR S R,BAR A,LULA A,YAGANTI S,TALAT L,et al.Treatment with repeat dexamethasone implants results in long-term disease control in eyes with noninfectious uveitis［J］.Ophthalmology,2014,121(8):1649-1654.

相似文献/References:

[1]唐耀冰 陈桂英 王晓艳 侯明佳.玻璃体内注射Infliximab治疗大鼠葡萄膜炎的实验研究[J].眼科新进展,2013,33(7):000.
[2]罗文婷 孙大卫.血管黏附蛋白-1在眼科疾病中的研究进展[J].眼科新进展,2013,33(8):000.
[3]刘莹 李林 高晓唯.肿瘤坏死因子拮抗剂在葡萄膜炎治疗中的应用[J].眼科新进展,2012,32(1):000.
[4]刘莹 李林 高晓唯 张振华 杨永利 赵旭东.玻璃体内注射 Infliximab对实验性自身免疫性葡萄膜炎的治疗作用[J].眼科新进展,2012,32(2):000.
[5]陈海婷,王红.生物制剂在葡萄膜炎治疗中的应用[J].眼科新进展,2010,30(5):000.
[6]杨婷婷,邓娟,梁雪梅. 葡萄膜炎患者血清胆红素、尿酸及白蛋白浓度分析[J].眼科新进展,2014,34(4):358.[doi:10.13389/j.cnki.rao.2014.0097]
[7]于晋懿,卢弘. 非感染性葡萄膜炎的免疫抑制治疗[J].眼科新进展,2014,34(7):695.[doi:10.13389/j.cnki.rao.2014.0191]
[8]郭建全.曲安奈德对年龄相关性白内障术后前葡萄膜炎的疗效及其对炎症因子的影响[J].眼科新进展,2014,34(8):769.[doi:10.13389/j.cnki.rao.2014.0212]
　GUO Jian-Quan.Efficacy of triamcinolone acetonide for anterior uveitis after age-related cataract surgery and its impact on inflammatory cytokines[J].Recent Advances in Ophthalmology,2014,34(6):769.[doi:10.13389/j.cnki.rao.2014.0212]
[9]张沐,康丽华,管怀进.MicroRNA相关单核苷酸多态性与眼部疾病关系的研究进[J].眼科新进展,2014,34(11):1083.[doi:10.13389/j.cnki.rao.2014.0301]
　ZHANG Mu,KANG Li-Hua,GUAN Huai-Jin.Recent advances in relationship between microRNA-related SNPs and ocular diseases[J].Recent Advances in Ophthalmology,2014,34(6):1083.[doi:10.13389/j.cnki.rao.2014.0301]
[10]张莲,毕宏生,郭俊国.抗TNF生物制剂在葡萄膜炎临床治疗中的应用进展[J].眼科新进展,2014,34(12):1187.[doi:10.13389/j.cnki.rao.2014.0330]
　ZHANG Lian,BI Hong-Sheng,GUO Jun-Guo.Application progress of anti-TNF biologic agents for uveitis[J].Recent Advances in Ophthalmology,2014,34(6):1187.[doi:10.13389/j.cnki.rao.2014.0330]

更新日期/Last Update: 2023-06-05