Private Retina Office, University of Buenos Aires, Argentina.
Department of Ophthalmology, University of Leipzig, Germany.
Retina. 2019 Jan;39(1):44-51. doi: 10.1097/IAE.0000000000002196.
To investigate efficacy and safety of repeated dexamethasone (DEX) implants over 24 months, in diabetic macular edema (DME) eyes that were treatment naive compared with eyes refractory to anti-vascular endothelial growth factor treatment, in a real-life environment.
This multicenter international retrospective study assessed best-corrected visual acuity and central subfield thickness (CST) of naive and refractory eyes to anti-vascular endothelial growth factor injections treated with dexamethasone implants. Safety data (intraocular pressure rise and cataract surgery) were recorded.
A total of 130 eyes from 125 patients were included. Baseline best-corrected visual acuity and CST were similar for naive (n = 71) and refractory eyes (n = 59). Both groups improved significantly in vision after 24 months (P < 0.001). However, naive eyes gained statistically significantly more vision than refractory eyes (+11.3 ± 10.0 vs. 7.3 ± 2.7 letters, P = 0.01) and were more likely to gain ≥10 letters (OR 3.31, 95% CI 1.19-9.24, P = 0.02). At 6, 12, and 24 months, CST was significantly decreased compared with baseline in both naive and refractory eyes; however, CST was higher in refractory eyes than in naive eyes (CST 279 ± 61 vs. 313 ± 125 μm, P = 0.10).
Over a follow-up of 24 months, vision improved in diabetic macular edema eyes after treatment with dexamethasone implants, both in eyes that were treatment naive and eyes refractory to anti-vascular endothelial growth factor treatment; however, improvement was greater in naive eyes.
在真实环境中，研究与抗血管内皮生长因子治疗抵抗的糖尿病黄斑水肿（DME）眼相比，初次接受治疗的 DME 眼在 24 个月内重复使用地塞米松（DEX）植入物的疗效和安全性。
本多中心国际回顾性研究评估了初次接受治疗的 DME 眼（n=71）和抗血管内皮生长因子治疗抵抗的 DME 眼（n=59）接受地塞米松植入物治疗后的最佳矫正视力和中央视网膜厚度（CST）。记录了安全性数据（眼压升高和白内障手术）。
共纳入 125 例患者的 130 只眼。初次治疗组（n=71）和治疗抵抗组（n=59）的基线最佳矫正视力和 CST 相似。两组在 24 个月后视力均显著提高（P<0.001）。然而，初次治疗组比治疗抵抗组获得了更多的视力提高（+11.3±10.0 vs.+7.3±2.7 个字母，P=0.01），且更有可能提高≥10 个字母（OR 3.31，95%CI 1.19-9.24，P=0.02）。在 6、12 和 24 个月时，与基线相比，初次治疗组和治疗抵抗组的 CST 均显著降低；然而，治疗抵抗组的 CST 仍高于初次治疗组（CST 279±61 vs.313±125μm，P=0.10）。
在 24 个月的随访中，接受地塞米松植入物治疗后，糖尿病黄斑水肿眼的视力均得到改善，无论是否初次接受治疗；然而，初次治疗组的改善更为明显。
