García Layana Alfredo, Adán Alfredo, Ascaso Francisco Javier, Cabrera Francisco, Donate Juan, Escobar Barranco José Juan, Peralta Gema, Reyes García Rebeca, Rodríguez Maqueda Mariano, Ruiz-Moreno José María, Vinagre Irene
Clínica Universitaria de Navarra, Pamplona, Spain.
RETICS de Oftalmología Oftared, Red Temática de Investigación Cooperativa en Salud: "Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain.
Eur J Ophthalmol. 2020 Sep;30(5):1042-1052. doi: 10.1177/1120672119861623. Epub 2019 Jul 10.
The aim of this study is to develop guidance on the use of intravitreal dexamethasone implants in the treatment of diabetic macular edema.
The study was performed using the modified Delphi method to obtain a consensus among a panel of experts on management of patients with diabetic macular edema and use of intravitreal dexamethasone implants in clinical practice. Thirty-seven panel members, experts on retina, from different Spanish centers were invited to participate. Individual and anonymous opinions were asked by answering a 76-item questionnaire across 11 topic areas (two rounds were done). Level of agreement was assessed using a Likert-type scale of 9 points.
Agreement on "consensus" was reached during the first round in 63 items. The 13 remaining items underwent a second round of voting. After the second round, agreement on "consensus" was reached on five items. Finally, eight items remained without consensus.
Intravitreal dexamethasone implants are useful in the treatment of patients with diabetic macular edema with different profiles, for example, pseudophakic, poor-adherents, vitrectomized, candidates for cataract surgery, patients with high inflammatory component, and with a history of cardiovascular events. The use of intravitreal dexamethasone reduces the number of visits and facilitates compliance. Experts thought that the switch from anti-vascular endothelial growth factor therapy to intravitreal dexamethasone implants should be done preferably after three injections. Also, pro re nata treatment provides better results in diabetic macular edema patients as it helps to prevent undertreatment. Finally, experts concluded that clinical guidelines and treatment protocols for diabetic macular edema need to be updated.
本研究旨在制定关于玻璃体内注射地塞米松植入物治疗糖尿病性黄斑水肿的使用指南。
本研究采用改良德尔菲法，以就糖尿病性黄斑水肿患者的管理及玻璃体内注射地塞米松植入物在临床实践中的应用，在一组专家中达成共识。邀请了来自西班牙不同中心的37名视网膜专家组成员参与。通过回答一份涵盖11个主题领域的76项问卷（进行两轮）来征求个人匿名意见。使用9分的李克特量表评估一致程度。
第一轮中有63项达成了“共识”。其余13项进行第二轮投票。第二轮投票后，有5项达成了“共识”。最后，有8项未达成共识。
玻璃体内注射地塞米松植入物对不同特征的糖尿病性黄斑水肿患者，如人工晶状体眼、依从性差者、玻璃体切除术后患者、白内障手术候选者、炎症成分高的患者以及有心血管事件病史的患者，治疗有效。玻璃体内注射地塞米松可减少就诊次数并提高依从性。专家们认为，从抗血管内皮生长因子治疗转换为玻璃体内注射地塞米松植入物，最好在三次注射后进行。此外，按需治疗在糖尿病性黄斑水肿患者中能取得更好的效果，因为它有助于防止治疗不足。最后，专家们得出结论，糖尿病性黄斑水肿的临床指南和治疗方案需要更新。
