F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA.
F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.
Am J Ophthalmol. 2018 Jul;191:14-22. doi: 10.1016/j.ajo.2018.03.027. Epub 2018 Mar 24.
To describe clinical outcomes associated with the use of topical difluprednate in treating uveitic cystoid macular edema.
Retrospective, interventional case series.
Setting: Medical record review in a tertiary care uveitis center.
Fifty-eight patients (72 eyes) with uveitic cystoid macular edema (CME) treated with difluprednate 0.05% ophthalmic solution between June 2012 and May 2016.
Macular central subfield thickness (CST) determined by optical coherence tomography, improvement of CME (≥20% reduction in CST or resolution), and resolution of CME (CST ≤ 320 μm with no cysts) at 30 days after starting treatment. Outcomes were assessed up to 90 days.
CST on average decreased by 17% (95% CI: -33%, -7%) for eyes using only difluprednate (n = 43) and by 6% (95% CI: -17%, -2%) for eyes in patients using concomitant systemic immunosuppressive therapy (n = 29) at 30 days, a 12% difference between groups (95% CI: 2%, 21%, P = .02). Of eyes on difluprednate alone, 76% had improvement and 48% had resolution of CME. In patients using systemic therapy, 37% of eyes had improvement and 17% had resolution. Eight eyes (11%) had an intraocular pressure (IOP) > 24 mm Hg within the first 30 days. By 90 days, CME had improved in 69% of all eyes and resolved in 43% of eyes, with only 9 patients starting or increasing systemic immunosuppressive medications and 2 patients receiving periocular corticosteroid injections.
Difluprednate was associated with an improvement in uveitic CME and could be a reasonable first-line therapy. IOP should be closely monitored.
描述局部应用二氟泼尼酯治疗葡萄膜炎性囊样黄斑水肿的临床结果。
回顾性、干预性病例系列研究。
研究地点：在一家三级护理葡萄膜炎中心进行病历回顾。
2012 年 6 月至 2016 年 5 月期间，58 例（72 只眼）葡萄膜炎性囊样黄斑水肿患者接受二氟泼尼酯 0.05%眼用溶液治疗。
采用光学相干断层扫描（OCT）测量黄斑中心小凹区厚度（CST），评估治疗后 30 天内 CME 改善（CST 降低≥20%或完全消退）和 CME 消退（CST≤320μm 且无囊泡）情况。结果评估最长可达 90 天。
仅使用二氟泼尼酯的眼（n=43），平均 CST 降低 17%（95%CI：-33%，-7%），同时使用全身免疫抑制治疗的眼（n=29）降低 6%（95%CI：-17%，-2%），两组间差异为 12%（95%CI：2%，21%，P=0.02）。单独使用二氟泼尼酯的眼，76%改善，48%消退。全身治疗的眼，37%改善，17%消退。治疗后 30 天内，有 8 只眼（11%）眼压（IOP）>24mmHg。90 天时，所有眼的 CME 改善率为 69%，消退率为 43%，仅 9 例患者开始或增加全身免疫抑制药物治疗，2 例患者接受眼周皮质类固醇注射。
二氟泼尼酯治疗葡萄膜炎性 CME 有效，可作为合理的一线治疗方法。应密切监测 IOP。
