Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Am J Ophthalmol. 2011 Apr;151(4):630-6. doi: 10.1016/j.ajo.2010.10.005. Epub 2011 Feb 1.
To evaluate outcomes in birdshot chorioretinopathy following intravitreal implantation of a fluocinolone acetonide-containing drug delivery device.
Retrospective, multicenter, interventional case study.
University- and community-based tertiary care. Twenty-two HLA-A29+ birdshot patients (36 eyes) were implanted with a sustained-release corticosteroid device and followed for up to 3 years. Main outcome measures were Snellen acuity, intraocular inflammation, adjunctive therapy, cataract, ocular hypertension, or glaucoma. Paired Wilcoxon statistics were used to analyze visual acuities; paired McNemar statistics were used to analyze presence or absence of other outcomes.
Nineteen of 22 patients (32 eyes) completed 12 months of follow-up with improvement in median visual acuity (P=.015). Prior to implantation, 18 of 22 patients (82%) received immunosuppressive therapy versus 1 of 19 (5%) by 12 months (P<.001). Eyes with zero vitreous haze increased from 7 of 27 scored eyes (26%) at baseline to 30 of 30 eyes (100%) by 12 months (P<.001). Cystoid macular edema decreased from 13 of 36 eyes (36%) at baseline to 2 of 32 eyes (6%) at 12 months (P=.006). Five of 24 phakic eyes at baseline exited the study before surgery; all other eyes received cataract surgery. One hundred percent of study eyes had ocular hypertension, required intraocular pressure-lowering therapy, or had glaucoma surgery by 12 months.
Implantation of a fluocinolone acetonide-containing intraocular device in birdshot chorioretinopathy can improve vision, control inflammation, and eliminate systemic therapy. There is a high incidence of cataract progression and intraocular hypertension or glaucoma.
评估玻璃体内植入氟轻松醋酸酯载药装置后对鸟枪弹样脉络膜视网膜病变的治疗效果。
回顾性、多中心、干预性病例研究。
在大学和社区的三级保健中心进行。对 22 名 HLA-A29+ 的鸟枪弹样患者（36 只眼）植入了一种缓释皮质类固醇装置，并进行了长达 3 年的随访。主要观察指标包括视力、眼内炎症、辅助治疗、白内障、眼压升高或青光眼。采用配对 Wilcoxon 统计分析视力变化；采用配对 McNemar 统计分析其他结果的有无。
22 名患者中的 19 名（32 只眼）完成了 12 个月的随访，其中中位数视力有所改善（P=.015）。在植入前，22 名患者中有 18 名（82%）接受了免疫抑制治疗，而在 12 个月时，19 名患者中有 1 名（5%）接受了免疫抑制治疗（P<.001）。无玻璃体内混浊的眼数从基线时的 27 只眼中的 7 只（26%）增加到 12 个月时的 30 只眼中的 30 只（100%）（P<.001）。黄斑囊样水肿从 36 只眼中的 13 只（36%）减少到 32 只眼中的 2 只（6%）（P=.006）。基线时有 5 只非白内障眼在手术前退出了研究；所有其他眼均接受了白内障手术。到 12 个月时，所有研究眼均有眼压升高，需要降低眼压治疗或接受青光眼手术。
在鸟枪弹样脉络膜视网膜病变中植入含有氟轻松醋酸酯的眼内装置可以改善视力、控制炎症并消除全身治疗。白内障进展和眼内压升高或青光眼的发生率较高。
