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玻璃体内注射地塞米松植入物治疗感染性葡萄膜炎继发黄斑水肿的安全性和有效性

SAFETY AND EFFICACY OF INTRAVITREAL DEXAMETHASONE IMPLANTS IN THE MANAGEMENT OF MACULAR EDEMA SECONDARY TO INFECTIOUS UVEITIS.

作者信息

Fonollosa Alex, Llorenç Victor, Artaraz Joseba, Jimenez Beatriz, Ruiz-Arruza Ioana, Agirrebengoa Koldo, Cordero-Coma Miguel, Costales-Mier Felipe, Adan Alfredo

机构信息

*Begiker-Ophthalmology Research Group, Ophthalmology Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Bilbao, Spain; †Ophthalmology Institute, Hospital Clinic of Barcelona, Barcelona, Spain; ‡Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Bilbao, Spain; §Infectious Disease Department, BioCruces Health Research Institute, Cruces Hospital, University of the Basque Country, Bilbao, Spain; and ¶Uveitis Unit, Ophthalmology Department, León Hospital, IBIOMED, León University, León, Spain.

出版信息

Retina. 2016 Sep;36(9):1778-85. doi: 10.1097/IAE.0000000000001001.

Abstract

PURPOSE

To assess the safety and efficacy of intravitreal dexamethasone implants in the treatment of macular edema secondary to infectious uveitis.

METHODS

We retrospectively reviewed clinical records from three uveitis referral units in Spain. The main outcome measures were rate of reactivation of infection, improvements in visual acuity and resolution of macular edema, as measured by optical coherence tomography.

RESULTS

We included eight eyes from seven patients with a median age of 64 years (30-75). Etiologies of the infections were Herpes simplex virus-type 1, Varicela-Zoster virus, Treponema pallidum, Brucella mellitensis, Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus. Median visual acuity was 20/160 (20/30-20/400) at baseline and 20/70 (20/25-20/200) at the last follow-up visit. Mean macular thickness was 516 μm (115) at baseline and 266.3 μm (40) at the last follow-up visit. Visual acuity improved in 100% of the eyes and none of the eyes showed macular edema at the last follow-up visit. Five patients required reinjections of the implant. Only one patient required antiglaucoma drops for a temporary increase in ocular pressure. There were no cases of reactivation of the infectious ocular disease. Median follow-up time was 18 months.

CONCLUSION

In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.

摘要

目的

评估玻璃体内注射地塞米松植入物治疗感染性葡萄膜炎继发黄斑水肿的安全性和有效性。

方法

我们回顾性分析了西班牙三个葡萄膜炎转诊单位的临床记录。主要观察指标为感染复发率、视力改善情况以及通过光学相干断层扫描测量的黄斑水肿消退情况。

结果

我们纳入了7例患者的8只眼,中位年龄为64岁(30 - 75岁)。感染病因包括1型单纯疱疹病毒、水痘 - 带状疱疹病毒、梅毒螺旋体、羊布鲁氏菌、伯氏疏螺旋体、弓形虫和巨细胞病毒。基线时中位视力为20/160(20/30 - 20/400),末次随访时为20/70(20/25 - 20/200)。基线时平均黄斑厚度为516μm(115),末次随访时为266.3μm(40)。所有眼睛的视力均有改善,末次随访时无一只眼睛出现黄斑水肿。5例患者需要再次注射植入物。仅1例患者因眼压暂时升高需要使用抗青光眼滴眼液。没有感染性眼病复发的病例。中位随访时间为18个月。

结论

在这个感染性葡萄膜炎继发黄斑水肿的小病例系列中,玻璃体内注射地塞米松植入物治疗与感染性眼病复发无关。此外,我们的患者视力和黄斑厚度有显著改善。

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