G.B. Bietti Foundation, IRCCS, Rome, Italy.
Am J Ophthalmol. 2013 Jan;155(1):127-133.e2. doi: 10.1016/j.ajo.2012.06.026. Epub 2012 Sep 18.
To evaluate the efficacy and safety of prompt intravitreal triamcinolone acetonide injection (4 mg/0.1 mL) vs intravitreal bevacizumab injection (1.25 mg/0.05 mL) compared with observation in the management of extensive exudative retinal detachment secondary to posterior uveal melanoma.
Retrospective, nonrandomized, interventional case series.
setting: Institutional. patients: Ninety-six patients affected by posterior uveal melanoma with large exudative retinal detachment (>10 mm in largest basal diameter) were included. intervention: Patients received intravitreal triamcinolone acetonide (32 eyes) or intravitreal bevacizumab (32 eyes) at plaque removal. Thirty-two patients served as controls (observation group). All groups were matched for age, sex, initial tumor thickness and largest basal diameter, largest exudative retinal detachment basal diameter, tumor location, and Bruch membrane rupture. Patients underwent monthly follow-up examinations in the first 6 months and every 3 months thereafter. Follow-up was longer than 24 months. main outcome measure: Exudative retinal detachment resolution (B-scan ultrasonography), steroid-induced cataract, steroid-induced increased IOP.
Follow-up was 37 ± 7 months. Marked exudative retinal detachment regression was documented in 22 (69%) intravitreal triamcinolone acetonide-treated vs 11 (34%) intravitreal bevacizumab-treated and 9 (28%) untreated eyes (P = .0007 and P = .0001, respectively). No statistical significance was found between intravitreal bevacizumab group vs observation group (P = .45) Steroid-induced cataract was observed in 4 intravitreal triamcinolone acetonide-treated patients (12%). Neither steroid-induced increased IOP nor other short- or long-term side effects were documented.
Intraoperative intravitreal triamcinolone acetonide injection induces earlier and marked exudative retinal detachment resolution after brachytherapy of posterior uveal melanoma. Risk and benefit should be balanced vs steroid-induced cataract.
评估玻璃体腔内曲安奈德（4 毫克/0.1 毫升）注射与玻璃体腔内贝伐单抗（1.25 毫克/0.05 毫升）注射与观察治疗葡萄膜后发性黑色素瘤引起的广泛渗出性视网膜脱离的疗效和安全性。
回顾性、非随机、干预性病例系列。
地点：机构。患者：96 例葡萄膜后发性黑色素瘤患者，伴有大的渗出性视网膜脱离（最大基底直径>10 毫米）。干预：患者在斑块切除时接受玻璃体腔内曲安奈德（32 只眼）或玻璃体腔内贝伐单抗（32 只眼）注射。32 例患者作为对照组（观察组）。所有组在年龄、性别、初始肿瘤厚度和最大基底直径、最大渗出性视网膜脱离基底直径、肿瘤位置、Bruch 膜破裂等方面均匹配。所有患者在前 6 个月内每月进行随访检查，此后每 3 个月进行一次。随访时间超过 24 个月。主要观察指标：渗出性视网膜脱离消退（B 型超声检查）、皮质类固醇性白内障、皮质类固醇性眼压升高。
随访时间为 37±7 个月。在玻璃体腔内曲安奈德治疗组中，22 只眼（69%）显著消退渗出性视网膜脱离，11 只眼（34%）玻璃体腔内贝伐单抗治疗组和 9 只眼（28%）未治疗组（P=0.0007 和 P=0.0001）。玻璃体腔内贝伐单抗组与观察组之间无统计学差异（P=0.45）。在玻璃体腔内曲安奈德治疗组中有 4 例（12%）出现皮质类固醇性白内障。未发现皮质类固醇性眼压升高或其他短期或长期副作用。
葡萄膜后发性黑色素瘤近距离放疗后，术中玻璃体腔内曲安奈德注射可更早、更显著地消退渗出性视网膜脱离。应权衡风险和益处，以避免皮质类固醇性白内障的发生。
