Fabiani Claudia, Emmi Giacomo, Lopalco Giuseppe, Vannozzi Lorenzo, Bacherini Daniela, Guerriero Silvana, Franceschini Rossella, Frediani Bruno, Iannone Florenzo, Marco Tosi Gian, Rigante Donato, Cantarini Luca
Department of Ophthalmology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Department of Experimental and Clinical Medicine, Eye Clinic, University of Florence, Florence, Italy.
Isr Med Assoc J. 2017 Jul;19(7):415-419.
The evidence on the use of dexamethasone implants in the treatment of Behçet's disease (BD)-related uveitis is limited to a few cases.
To evaluate the efficacy of dexamethasone implants on ocular functional, morphological, and clinical parameters in BD patients with severe refractory uveitis.
Five eyes from five BD patients were enrolled. A single intravitreal dexamethasone injection was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT) assessed with optical coherence tomography, retinal vasculitis assessed by fluorescein angiography, vitreous haze score (Nussenblatt scale), intraocular pressure (IOP), and lens status (LOCS III, Lens Opacities Classification System III) were recorded at baseline and at 1, 3, and 6 month follow-up visits.
At baseline, all eyes showed marked macular edema and 4/5 had concomitant active retinal vasculitis. Mean BCVA was increased from baseline at each control visit with a mean improvement of 0.26 ± 0.18 lines at 6 months follow-up. Mean CMT decreased from baseline at each control visit with a mean improvement at 6 months follow-up of 198.80 ± 80.08 µm. At the end of the study, none of the eyes showed macular edema and the mean CMT was 276.80 ± 24.94 µm. Retinal vasculitis resolved in all eyes. One eye experienced an IOP spike during treatment that resolved spontaneously, and one eye developed a clinically significant lens opacity at 6 months follow-up.
Treatment with a dexamethasone implant in BD-uveitis and inflammatory macular edema was safe and effective as an additional treatment combined with systemic immunomodulatory drugs.
关于地塞米松植入物用于治疗白塞病（BD）相关葡萄膜炎的证据仅限于少数病例。
评估地塞米松植入物对重度难治性葡萄膜炎BD患者眼部功能、形态和临床参数的疗效。
纳入5例BD患者的5只眼。每只眼均接受单次玻璃体内地塞米松注射。在基线以及随访1、3和6个月时记录最佳矫正视力（BCVA）、光学相干断层扫描评估的中心黄斑厚度（CMT）、荧光素血管造影评估的视网膜血管炎、玻璃体混浊评分（努森布拉特量表）、眼压（IOP）和晶状体状态（LOCS III，晶状体混浊分类系统III）。
基线时，所有眼睛均显示明显的黄斑水肿，5只眼中4只伴有活动性视网膜血管炎。每次对照访视时，平均BCVA均较基线增加，随访6个月时平均提高0.26±0.18行。每次对照访视时，平均CMT均较基线降低，随访6个月时平均改善198.80±80.08 µm。研究结束时，所有眼睛均未显示黄斑水肿，平均CMT为276.80±24.94 µm。所有眼睛的视网膜血管炎均消退。1只眼在治疗期间出现眼压峰值，随后自行消退，1只眼在随访6个月时出现具有临床意义的晶状体混浊。
作为与全身免疫调节药物联合使用的附加治疗，地塞米松植入物治疗BD相关性葡萄膜炎和炎性黄斑水肿安全有效。
