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玻璃体内糖皮质激素植入疗法治疗视网膜静脉阻塞所致黄斑水肿的有效性和安全性评估

Evaluation of the effectiveness and safety of glucocorticoids intravitreal implant therapy in macular edema due to retinal vein occlusion.

作者信息

Michalska-Małecka Katarzyna, Gaborek Aneta, Nowak Mariusz, Halat Tomasz, Pawłowska Mariola, Śpiewak Dorota

机构信息

Department of Ophthalmology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; University Center of Ophthalmology and Oncology, Independent Public Clinical Hospital, Medical University of Silesia, Katowice, Poland.

University Center of Ophthalmology and Oncology, Independent Public Clinical Hospital, Medical University of Silesia, Katowice, Poland.

出版信息

Clin Interv Aging. 2016 May 23;11:699-705. doi: 10.2147/CIA.S96674. eCollection 2016.

Abstract

The purpose of this study was to evaluate the impact of intravitreal dexamethasone implant (Ozurdex) on macular morphology and functions in eyes with macular edema (ME) secondary to retinal vein occlusion. Efficacy outcomes of the treatment were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety outcomes were intraocular pressure and cornea endothelial cell density. The study was conducted by the prospective analysis on 36 patients (17 women and 19 men) aged 28-77 years (the average age was 58±15 years) treated with the injection of dexamethasone implant because of the persistent ME at the Department of Ophthalmology and Ophthalmology Outpatient Clinic of the University Centre of Ophthalmology and Oncology in Katowice. The studied group included 16 patients with central retinal vein occlusion (16 eyes), and 20 patients with branch retinal vein occlusion (20 eyes). We found a significant increase of BCVA after first, second, and third month of treatment. Six months after the treatment, BCVA decreased, although not significantly compared with the value obtained in the third month. Two months after the intravitreal implantation of dexamethasone delivery system, CRT was 338±163 μm and was significantly lower compared with pretreatment value. Between third and sixth month after the treatment, we found insignificant increase of CRT compared with thickness observed in second month. Two months after the treatment, we found an increase in intraocular pressure in 36% of cases and a further decrease during the final visit 6 months after the treatment. During the treatment, there were no significant differences in endothelial cell density in branch retinal vein occlusion and central retinal vein occlusion. We found the intravitreal dexamethasone implant to be safe, well tolerated, and likely to lead to fast morphological and functional improvement of the macula and visual rehabilitation in patients with ME due to retinal vein occlusion.

摘要

本研究旨在评估玻璃体内注射地塞米松植入剂(Ozurdex)对视网膜静脉阻塞继发黄斑水肿(ME)患者黄斑形态及功能的影响。治疗的疗效指标为最佳矫正视力(BCVA)和中心视网膜厚度(CRT)。安全性指标为眼压和角膜内皮细胞密度。本研究通过对36例患者(17例女性和19例男性)进行前瞻性分析,这些患者年龄在28 - 77岁(平均年龄为58±15岁),因持续性黄斑水肿在卡托维兹眼科与肿瘤学大学中心眼科及眼科门诊接受地塞米松植入剂注射治疗。研究组包括16例中心视网膜静脉阻塞患者(16只眼)和20例分支视网膜静脉阻塞患者(20只眼)。我们发现治疗第1、2和3个月后BCVA显著提高。治疗6个月后,BCVA有所下降,尽管与第3个月时的值相比差异不显著。玻璃体内植入地塞米松给药系统2个月后,CRT为338±163μm,与治疗前值相比显著降低。在治疗后第3至6个月,我们发现CRT与第2个月时观察到的厚度相比有不显著增加。治疗2个月后,我们发现36%的病例眼压升高,在治疗后6个月的最后一次随访时进一步下降。在治疗期间,分支视网膜静脉阻塞和中心视网膜静脉阻塞患者的内皮细胞密度无显著差异。我们发现玻璃体内注射地塞米松植入剂安全、耐受性良好,并且可能使视网膜静脉阻塞继发黄斑水肿患者的黄斑形态和功能快速改善以及视力恢复。

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