Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, Kansas, USA.
Retina. 2010 Feb;30(2):260-6. doi: 10.1097/iae.0b013e3181b8628e.
The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory drugs (NSAIDs) to intravitreal corticosteroid and antivascular endothelial growth factor injections for the treatment of chronic cystoid macular edema.
Thirty-nine patients with chronic pseudophakic cystoid macular edema completed a single-center, randomized, investigator-masked study. All patients were treated with an intravitreal triamcinolone and bevacizumab injection at study entry; the bevacizumab injection was repeated at 1 month. To evaluate the effect of adding an NSAID, patients were randomized to treatment with 1 of 4 topical NSAIDs (diclofenac 0.1%, ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09%) or placebo for 16 weeks.
At Weeks 12 and 16, both the nepafenac and bromfenac groups showed a significant reduction in retinal thickness compared with that in placebo (nepafenac, P = 0.0048, bromfenac, P = 0.0113). A difference, however, between these 2 NSAID groups was observed in that only the nepafenac group was able to maintain the demonstrated retinal thickness decrease at Weeks 12 and 16. The nepafenac group also experienced a significant improvement in visual acuity at Weeks 12 (P = 0.0084) and 16 (P = 0.0233). The addition of NSAIDs did not produce an increase in mean intraocular pressure over the course of therapy.
Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.
本研究旨在评估在玻璃体内皮质类固醇和抗血管内皮生长因子注射治疗慢性囊样黄斑水肿的基础上添加局部非甾体抗炎药（NSAIDs）的效果。
39 名患有慢性假性囊样黄斑水肿的患者完成了一项单中心、随机、研究者盲法研究。所有患者在研究开始时均接受玻璃体内曲安奈德和贝伐单抗注射治疗；贝伐单抗注射在 1 个月时重复。为了评估添加 NSAID 的效果，患者随机接受 4 种局部 NSAID（双氯芬酸 0.1%、酮咯酸 0.4%、奈帕芬酸 0.1%和溴芬酸钠 0.09%）或安慰剂治疗 16 周。
在第 12 周和第 16 周，奈帕芬酸组和溴芬酸钠组的视网膜厚度与安慰剂组相比均显著降低（奈帕芬酸，P = 0.0048，溴芬酸钠，P = 0.0113）。然而，这两种 NSAID 组之间存在差异，只有奈帕芬酸组能够维持第 12 周和第 16 周显示的视网膜厚度降低。奈帕芬酸组在第 12 周（P = 0.0084）和第 16 周（P = 0.0233）时视力也显著改善。在治疗过程中，添加 NSAIDs 不会导致平均眼压升高。
尽管 NSAID 治疗似乎增强了皮质类固醇和抗血管内皮生长因子治疗慢性假性囊样黄斑水肿的效果，但只有奈帕芬酸和溴芬酸钠治疗的眼睛在 12 周和 16 周时显示出视网膜厚度降低。此外，奈帕芬酸可持续改善视力。
