Gupta Amod, Gupta Vishali, Thapar Shveta, Bhansali Anil
Department of Ophthalmology, Postgraduate Institute of Education and Research, Chandigarh, India.
Am J Ophthalmol. 2004 Apr;137(4):675-82. doi: 10.1016/j.ajo.2003.11.017.
To determine the efficacy of the lipid-lowering drug atorvastatin in reducing retinal hard exudates and subfoveal lipid migration after focal/grid laser photocoagulation in clinically significant macular edema in patients with diabetes with elevated serum lipids.
Randomized case trial.
Thirty patients with type 2 diabetes with clinically significant macular edema, dyslipidemia, and hard exudates of grade 4 and above were assessed in an institutional setting. All patients were subjected to strict metabolic control within 4 to 6 weeks of enrollment. In addition, 15 patients in group A received atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A inhibitor; 15 members of group B did not receive any lipid-lowering therapy. All received laser photocoagulation after a metabolic control period and were followed up for a minimum of 18 weeks. The outcome measures were reduction in hard exudates, subfoveal lipid migration, status of macular edema, and visual acuity.
The study included 21 men and nine women with noninsulin-dependent diabetes mellitus who could achieve good metabolic control within 4 to 6 weeks of inclusion in the study. All patients had elevated serum lipids at baseline. Ten (66.6%) of 15 patients in treatment group A and two (13.3%) of 15 patients in control group B showed reduction in hard exudates (P =.007). None of the patients in group A and five (33.3%) of 15 in group B showed subfoveal lipid migration after laser photocoagulation (P =.04). Regression of macular edema was seen in nine eyes in group A and five in group B (P =.27). None of the eyes in group A and three eyes in group B showed worsening of visual acuity (P =.22).
Oral atorvastatin therapy in patients with type 2 diabetes with dyslipidemia reduces the severity of hard exudates and subfoveal lipid migration in clinically significant macular edema and could be an important adjunct in the management of clinically significant macular edema.
确定降脂药物阿托伐他汀在降低血清脂质升高的糖尿病患者发生的临床上显著的黄斑水肿经局部/格栅激光光凝治疗后视网膜硬性渗出物及黄斑中心凹下脂质迁移方面的疗效。
随机病例试验。
在机构环境中对30例患有临床上显著的黄斑水肿、血脂异常且有4级及以上硬性渗出物的2型糖尿病患者进行评估。所有患者在入组后4至6周内接受严格的代谢控制。此外，A组15例患者接受阿托伐他汀（一种3-羟基-3-甲基戊二酰辅酶A抑制剂）治疗；B组15例患者未接受任何降脂治疗。所有患者在代谢控制期后均接受激光光凝治疗，并至少随访18周。观察指标为硬性渗出物的减少、黄斑中心凹下脂质迁移、黄斑水肿状态及视力。
该研究纳入了21名男性和9名女性非胰岛素依赖型糖尿病患者，他们在纳入研究后4至6周内能够实现良好的代谢控制。所有患者基线时血清脂质均升高。治疗组A的15例患者中有10例（66.6%）、对照组B的15例患者中有2例（13.3%）的硬性渗出物减少（P = 0.007）。激光光凝治疗后，A组患者均未出现黄斑中心凹下脂质迁移，而B组15例患者中有5例（33.3%）出现（P = 0.04）。A组9只眼、B组5只眼的黄斑水肿消退（P = 0.27）。A组所有眼及B组3只眼的视力均未恶化（P = 0.22）。
对患有血脂异常的2型糖尿病患者进行口服阿托伐他汀治疗可降低临床上显著的黄斑水肿中硬性渗出物的严重程度及黄斑中心凹下脂质迁移，可能是临床上显著的黄斑水肿管理中的一项重要辅助措施。
