Kim M, Cho Y J, Lee C H, Lee S C
Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Eye (Lond). 2016 May;30(5):718-25. doi: 10.1038/eye.2016.23. Epub 2016 Mar 4.
AimsTo investigate the effect of intravitreal dexamethasone implant (IVD) on central foveal thickness (CFT), choroidal thickness (CT) and its correlation with visual acuity in eyes with refractory diabetic macular oedema (DMO).MethodsThis was a retrospective interventional case-series. Thirty-five eyes of 35 patients were treated with a single injection of IVD because of refractory DMO with CFT over 300 μm, and persistent intraretinal and subretinal fluid despite of multiple intravitreal bevacizumab injections. Patients were followed-up for 6 months for the evaluation of CFT and subfoveal CT by spectral-domain optical coherence tomography.ResultsAll eyes (mean age: 59.4±12.35 years; 18 males, 17 females) had been previously treated with multiple bevacizumab injections and showed persistent DMO (mean number of injections 4.08±2.98) The preoperative logMAR BCVA was 0.49±0.24, which gradually improved to 0.46±0.32 at 6 months (P=0.652) and 26% gained two or more lines of Snellen visual acuity. At baseline, the mean CFT was 526.29±123.48 μm, which significantly improved to 316.15±100.09 μm at 3 months (P<0.001). However, CFT deteriorated to 457.07±136.53 μm at 6 months (P=0.051). Similarly, the mean preoperative subfoveal CT was 288.91±36.47 μm and it decreased to 266.85±30.93 μm at 3 months (P<0.01), but increased to 278.63±32.55 μm at 6 months (P=0.137). The reduction of CFT from baseline showed significant correlation with that of subfoveal CT at 3 months (P=0.041) and at 6 months (P=0.008).ConclusionsIn DMO refractory to multiple bevacizumab injections, IVD significantly reduced CFT and subfoveal CT, with BCVA improvement in one-fourth of the patients. The reduction of CFT showed significant correlation with reduction of subfoveal CT.
目的
探讨玻璃体内注射地塞米松植入物（IVD）对难治性糖尿病性黄斑水肿（DMO）患者中心凹厚度（CFT）、脉络膜厚度（CT）的影响及其与视力的相关性。
方法
这是一项回顾性干预性病例系列研究。35例患者的35只眼因CFT超过300μm且尽管多次玻璃体内注射贝伐单抗仍存在视网膜内和视网膜下液的难治性DMO而接受单次IVD注射治疗。对患者进行6个月的随访，通过光谱域光学相干断层扫描评估CFT和黄斑中心下CT。
结果
所有患眼（平均年龄：59.4±12.35岁；男性18例，女性17例）此前均接受过多次贝伐单抗注射，表现为难治性DMO（平均注射次数4.08±2.98）。术前logMAR最佳矫正视力（BCVA）为0.49±0.24，6个月时逐渐改善至0.46±0.32（P = 0.652），26%的患者Snellen视力提高了两行或更多。基线时，平均CFT为526.29±123.48μm，3个月时显著改善至316.15±100.09μm（P<0.001）。然而，6个月时CFT恶化至457.07±136.53μm（P = 0.051）。同样，术前黄斑中心下CT平均为288.91±36.47μm，3个月时降至266.85±30.93μm（P<0.01），但6个月时升至278.63±32.55μm（P = 0.137）。3个月（P = 0.041）和6个月（P = 0.008）时，CFT从基线的降低与黄斑中心下CT的降低显著相关。
结论
在多次贝伐单抗注射难治的DMO中，IVD显著降低了CFT和黄斑中心下CT，四分之一的患者BCVA得到改善。CFT的降低与黄斑中心下CT的降低显著相关。
