Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan.
Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
Retina. 2018 Jun;38(6):1084-1090. doi: 10.1097/IAE.0000000000001720.
To investigate the efficacy of the intravitreal dexamethasone implant as the treatment for recalcitrant macular edema after successful rhegmatogenous retinal detachment repair.
A retrospective review of the medical records was performed on 17 consecutive patients (17 eyes) with recalcitrant macular edema associated with rhegmatogenous retinal detachment repair who were treated with a single or multiple injections of an intravitreal dexamethasone 0.7-mg implant (Ozurdex; Allergan Inc) at two centers. Main outcomes of the study were change in logarithm of the minimum angle of resolution visual acuity, measurement of central foveal thickness, and macular cube volume as measured by spectral domain optical coherence tomography and frequency of complications.
The mean age was 67 years (range, 51-78 years). All 17 patients received previous topical therapy and 12 of them had previous administration of intravitreal triamcinolone with persistence of macular edema. Baseline mean best-corrected visual acuity was 20/100 (logarithm of the minimum angle of resolution 0.75; range, 0.18-1.3 ±0.37) in the affected eyes. There was a statistically significant improvement in best-corrected visual acuity at 1 month (P < 0.001) and 3 months (P = 0.01). Mean baseline central foveal thickness was 505 μm, and mean macular cube volume was 10.62 mm. There was a statistically significant decrease in central foveal thickness and macular cube volume at 1 month (505-290 μm, P = 0.013 and 10.62-9.13 mm, P < 0.0001) and 3 months (P = 0.01). All patients developed recurrence of macular edema at 3 months, which required retreatment. The average number of implants was 4 (range, 1-14). No adverse effects such as retinal detachment or endophthalmitis occurred. Two patients experienced an increase in intraocular pressure that was controlled with topical therapy.
Macular edema that occurs in eyes after successful repair of rhegmatogenous retinal detachment can be chronic and recalcitrant, and may be successfully and safely treated with the dexamethasone intravitreal implant.
探讨玻璃体内注射地塞米松植入物治疗孔源性视网膜脱离修复后顽固黄斑水肿的疗效。
对在两个中心接受单次或多次玻璃体内注射 0.7mg 地塞米松植入物（Ozurdex；Allergan Inc）治疗的 17 例（17 只眼）伴有孔源性视网膜脱离修复后顽固黄斑水肿的患者的病历进行回顾性分析。本研究的主要结局是最小分辨角对数视力的变化、中央黄斑厚度的测量以及光谱域光相干断层扫描测量的黄斑立方体积，以及并发症的频率。
患者的平均年龄为 67 岁（51-78 岁）。所有 17 例患者均接受过局部治疗，12 例曾接受过玻璃体内曲安奈德治疗，但仍有黄斑水肿。受影响眼的基线平均最佳矫正视力为 20/100（最小分辨角对数 0.75；范围，0.18-1.3 ±0.37）。在 1 个月（P < 0.001）和 3 个月（P = 0.01）时，最佳矫正视力有统计学意义上的改善。基线中央黄斑厚度平均为 505μm，黄斑立方体积平均为 10.62mm。在 1 个月（505-290μm，P = 0.013）和 3 个月（P = 0.01）时，中央黄斑厚度和黄斑立方体积均有统计学意义上的下降。所有患者在 3 个月时均出现黄斑水肿复发，需要再次治疗。植入物的平均数量为 4 个（范围，1-14 个）。未发生视网膜脱离或眼内炎等不良反应。有 2 例患者眼压升高，经局部治疗得到控制。
孔源性视网膜脱离修复后发生的黄斑水肿可能是慢性和顽固的，可以用地塞米松玻璃体内植入物成功和安全地治疗。
