Zhioua Imène, Semoun Oudy, Lalloum Franck, Souied Eric H
Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil, University Paris XII, Creteil, France.
Retina. 2015 Jul;35(7):1429-35. doi: 10.1097/IAE.0000000000000490.
To study the efficacy of intravitreal injection (IVI) of dexamethasone implant as second-line treatment in patients with resistant chronic diabetic macular edema nonresponsive to 6 monthly consecutive IVI of ranibizumab.
A retrospective study was conducted over 9 months. Best-corrected visual acuity and central macular thickness were noted. Patients with best-corrected visual acuity ≤20/40 using Snellen chart, central macular thickness ≥300 μm, and poor response to 6 monthly consecutive IVI of ranibizumab were included. Patients received IVI of dexamethasone implant and were examined at 1, 3, 6, and 9 months.
Thirteen eyes of 12 patients were included (6 men and 6 women; mean age, 64 ± 7.8 years). Best-corrected visual acuity increased by a mean of 5.58 letters at Month 1 (P = 0.017), 4.61 at Month 3 (P = 0.05), 4.61 at Month 6 (P = 0.042), and 5.77 at Month 9 (P = 0.017). Central macular thickness decreased from 594 μm to 402 μm at Month 1 (P = 0.0002), 428 μm at Month 3 (P = 0.002), 459 μm at Month 6 (P = 0.02), and 489 μm at Month 9 (P = 0.03). Mean number of dexamethasone IVI was 1.07. Two patients (15.3%) developed elevated intraocular pressure, and 1 patient was operated for cataract at 6 months (9% of phakic patients).
Intravitreal injection of dexamethasone implant seems as an effective second-line treatment in diabetic macular edema persistent after 6 monthly consecutive intravitreal ranibizumab injections in real life.
研究玻璃体内注射地塞米松植入物作为二线治疗方法，用于对连续6个月每月一次玻璃体内注射雷珠单抗无反应的耐药性慢性糖尿病性黄斑水肿患者的疗效。
进行了为期9个月的回顾性研究。记录最佳矫正视力和中心黄斑厚度。纳入使用Snellen视力表最佳矫正视力≤20/40、中心黄斑厚度≥300μm且对连续6个月每月一次玻璃体内注射雷珠单抗反应不佳的患者。患者接受玻璃体内注射地塞米松植入物，并在1、3、6和9个月时进行检查。
纳入12例患者的13只眼（6例男性和6例女性；平均年龄64±7.8岁）。最佳矫正视力在第1个月平均提高5.58个字母（P = 0.017），第3个月提高4.61个字母（P = 0.05），第6个月提高4.61个字母（P = 0.042），第9个月提高5.77个字母（P = 0.017）。中心黄斑厚度在第1个月从594μm降至402μm（P = 0.0002），第3个月降至428μm（P = 0.002），第6个月降至459μm（P = 0.02），第9个月降至489μm（P = 0.03）。地塞米松玻璃体内注射的平均次数为1.07次。2例患者（15.3%）出现眼压升高，1例患者在6个月时因白内障接受手术（占晶状体眼患者的9%）。
在现实生活中，对于连续6个月每月一次玻璃体内注射雷珠单抗后仍持续存在的糖尿病性黄斑水肿，玻璃体内注射地塞米松植入物似乎是一种有效的二线治疗方法。
