Sudhalkar Aditya, Balakrishnan Divya, Jalali Subhadra, Narayanan Raja
Smt. Kanuri Santhamma Centre For Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
Saudi J Ophthalmol. 2016 Jan-Mar;30(1):14-9. doi: 10.1016/j.sjopt.2015.08.001. Epub 2015 Aug 8.
To determine the role of systemic steroids in improving visual acuity, preventing recurrence and hastening pigment epithelial detachment resolution in IPCV patients.
Retrospective computer assisted comparative case series of consecutive patients with documented IPCV who did and did not receive systemic steroids as part of their treatment regimen between 2007 and 2012. Patients who had systemic contraindication to steroid therapy were excluded from the steroid arm. Data collected included demographics, the best corrected visual acuity, details of the ocular and systemic exam, the treatment offered, the follow-up period and the final visual and anatomic outcomes. Outcome measures included the final BCVA, the time to resolution of the associated pigment epithelial detachment (PED, if present), the recurrence rate and the associated side effects, if any. Appropriate statistical analysis was done. Statistical significance: p < 0.05.
14 patients (14 eyes) had received systemic steroids in the stated period; these were compared with 26 consecutive patients (26 eyes) who did not. Mean age: 59.24 vs 62.38 years (A vs B). Mean baseline BCVA: 1.86 ± 1.24 logMAR vs 2.12 ± 1.48 logMAR (A vs B). 8 females in Group A and 14 in Group B. 11 patients in group A and 19 in group B had associated systemic hypertension. Therapy consisted of laser photocoagulation, anti-vascular endothelial growth factor therapy, photodynamic therapy or a combination of these. Mean follow-up: 43.21 ± 11.32 months (Group A) vs 48.24 ± 9.75 months (Group B). BCVA at three months was significantly better (0.84 ± 0.74 logMAR vs 1.16 ± 0.89 (p = 0.039). Final BCVA: 0.86 ± 0.78 logMAR (Group A) vs 1.29 ± 0.92 (Group B, p = 0.042). 7 patients in group A and 12 in Group B had a recurrence (insignificant difference). 1 patient in Group A and 7 in Group B had unresolved disease (persistent PED) at the end of follow-up (OR: 4.60; 95% CI 1.7-11.10).
Steroids appear to improve visual acuity and accelerate the resolution of the PEDs in patients with IPCV and large PEDs, but do not seem to influence recurrence.
确定全身应用类固醇激素在改善特发性息肉状脉络膜血管病变（IPCV）患者视力、预防复发及加速色素上皮脱离消退方面的作用。
对2007年至2012年间接受和未接受全身类固醇激素治疗的连续IPCV患者进行回顾性计算机辅助比较病例系列研究。有类固醇激素治疗全身禁忌证的患者被排除在类固醇激素治疗组之外。收集的数据包括人口统计学资料、最佳矫正视力、眼部和全身检查细节、所提供的治疗、随访期以及最终的视力和解剖学结果。结局指标包括最终的最佳矫正视力、相关色素上皮脱离（PED，如有）消退的时间、复发率以及相关副作用（如有）。进行了适当的统计分析。统计学显著性：p < 0.05。
在所述期间，14例患者（14只眼）接受了全身类固醇激素治疗；将其与26例连续未接受治疗的患者（26只眼）进行比较。平均年龄：59.24岁对62.38岁（A组对B组）。平均基线最佳矫正视力：1.86±1.24对数最小分辨角对数视力对2.12±1.48对数最小分辨角对数视力（A组对B组）。A组有8名女性，B组有14名女性。A组有11例患者，B组有19例患者伴有全身性高血压。治疗包括激光光凝、抗血管内皮生长因子治疗、光动力疗法或这些方法的联合应用。平均随访时间：A组为43.21±11.32个月，B组为（48.24±9.75个月）。三个月时的最佳矫正视力显著更好（0.84±0.74对数最小分辨角对数视力对1.16±0.89对数最小分辨角对数视力，p = 0.039）。最终最佳矫正视力：A组为0.86±0.78对数最小分辨角对数视力，B组为1.29±0.92对数最小分辨角对数视力（p = 0.042）。A组有7例患者，B组有12例患者复发（差异无统计学意义）。随访结束时，A组有1例患者，B组有7例患者疾病未缓解（持续性PED）（比值比：4.60；95%可信区间1.7 - 11.10）。
类固醇激素似乎能改善IPCV和大PED患者的视力并加速PED的消退，但似乎不影响复发。
