Cakir Akin, Erden Burak, Bolukbasi Selim, Bayat Alper Halil, Ozturan Seyma Gulcenur, Elcioglu Mustafa Nuri
Department of Opthalmology, Okmeydanı Research and Training Hospital, Darülaceze Cad. No:25 Şişli, 34367, Istanbul, Turkey.
Int Ophthalmol. 2019 Oct;39(10):2179-2185. doi: 10.1007/s10792-018-1053-5. Epub 2018 Nov 23.
This study evaluates the effectiveness of a single-dose dexamethasone implant (DI) as an auxiliary therapy to continued intravitreal ranibizumab (IVR) treatment in patients with persistent diabetic macular edema (DME).
Twenty-five pseudophakic eyes of 25 patients with DME who underwent a single injection of DI as an adjuvant therapy following an IVR loading dose were examined retrospectively. All patients were treatment naive and had a poor response to a loading dose of three consecutive monthly IVR injections. IVR treatments were continued pro re nata after the DI. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 1, 3, 6 and 8 months post-DI treatment.
After the IVR loading dose, the mean BCVA and CMT were 0.9 ± 0.6 LogMAR and 478.2 ± 107.8 µm, respectively. One month after the DI, the mean BCVA and CMT had improved to 0.6 ± 0.4 LogMAR (p = 0.005) and 313.8 ± 62.7 µm (p < 0.001), respectively. This improvement was maintained with mean 0.8 ± 0.8 IVR injections throughout the follow-up period. The final mean BCVA and CMT were 0.5 ± 0.5 LogMAR and 298.4 ± 71.5 µm. Subgroup analyses revealed that different DME types did not have any effect on CMT or BCVA improvement (p = 0.188, p = 0.136; respectively).
Adding DI results in rapid anatomical and visual improvement in patients who respond poorly to an IVR loading dose. Improvements may be maintained with additional IVR in follow-up.
本研究评估单剂量地塞米松植入物（DI）作为辅助治疗手段，用于持续玻璃体内注射雷珠单抗（IVR）治疗持续性糖尿病性黄斑水肿（DME）患者的有效性。
回顾性研究25例DME患者的25只假晶状体眼，这些患者在接受IVR负荷剂量后接受了单次DI注射作为辅助治疗。所有患者此前未接受过治疗，且对连续三个月每月一次的IVR负荷剂量反应不佳。DI注射后根据需要继续进行IVR治疗。主要观察指标为DI治疗后1、3、6和8个月时最佳矫正视力（BCVA）和中心黄斑厚度（CMT）的变化。
IVR负荷剂量后，平均BCVA和CMT分别为0.9±0.6 LogMAR和478.2±107.8μm。DI注射后1个月，平均BCVA和CMT分别改善至0.6±0.4 LogMAR（p = 0.005）和313.8±62.7μm（p < 0.001）。在整个随访期间，平均进行0.8±0.8次IVR注射，这种改善得以维持。最终平均BCVA和CMT分别为0.5±0.5 LogMAR和298.4±71.5μm。亚组分析显示，不同类型的DME对CMT或BCVA的改善没有任何影响（p分别为0.188和0.136）。
对于对IVR负荷剂量反应不佳的患者，添加DI可迅速实现解剖结构和视力改善。随访中额外进行IVR治疗可维持改善效果。
