Kong Xiangbin, Psaras Catherine, Stewart Jay M
University of California, San Francisco, Department of Ophthalmology, San Francisco, California; The Second People's Hospital of Foshan, Foshan, China.
University of California, San Francisco, Department of Ophthalmology, San Francisco, California.
Ophthalmol Retina. 2019 Nov;3(11):993-997. doi: 10.1016/j.oret.2019.05.030. Epub 2019 Jun 7.
To evaluate outcomes in patients with hypotony treated with intravitreal dexamethasone implant (Ozurdex).
Retrospective cohort study.
Thirteen patients (15 eyes) that received a total of 99 dexamethasone implant injections on occasions at which the intraocular pressure was low, meeting the definition of statistical hypotony.
The medical records of 13 patients (15 consecutive eyes) receiving 1 or more intravitreal dexamethasone implants between December 2014 and April 2017 were reviewed retrospectively. Hypotony was defined as intraocular pressure less than 6.5 mmHg. The indications for intravitreal dexamethasone implant injection were intermediate or posterior uveitis (86.7%), diabetic macular edema (13.3%), and/or cystoid macular edema (6.7%).
The primary outcome measures were safety outcomes and best visual acuity within 6 months of the final intravitreal dexamethasone implant injection in a hypotonous eye.
In 15 eyes (13 patients), 99 injections were administered to eyes under circumstances of hypotony. Uveitic cystoid macular edema or diabetic macular edema was reduced after treatment in all cases. No complications were noted during the injection procedure. Three complications were noted in 2 patients after injection. Pseudophakodonesis and mild vitreous hemorrhage immediately after injection were noted in 1 patient, and a case of delayed-onset vitreous hemorrhage with pigment release was noted in another. All 3 complications resolved without intervention. The primary end point of this study-mean visual acuity-was stable over the follow-up period. In patients with hypotony whose intraocular pressure normalized during the follow-up period, this was attributable to management of glaucoma surgery-related complications rather than an effect of the intravitreal dexamethasone implant.
Intravitreal dexamethasone implant injection is a reasonable treatment option for patients with comorbid hypotony in whom clinical findings warrant treatment with a sustained-delivery intravitreal steroid implant. Further studies, including imaging of zonules before and after intravitreal dexamethasone implant injection in a hypotonous eye, could help define risks to intraocular lens stability with this procedure.
评估玻璃体内注射地塞米松植入剂（Ozurdex）治疗低眼压患者的疗效。
回顾性队列研究。
13例患者（15只眼），在眼压较低时共接受了99次地塞米松植入剂注射，符合统计学低眼压的定义。
回顾性分析2014年12月至2017年4月期间接受1次或多次玻璃体内地塞米松植入剂治疗的13例患者（15只连续眼）的病历。低眼压定义为眼压低于6.5 mmHg。玻璃体内注射地塞米松植入剂的适应证为中间葡萄膜炎或后葡萄膜炎（86.7%）、糖尿病性黄斑水肿（13.3%）和/或黄斑囊样水肿（6.7%）。
主要观察指标为低眼压眼中最后一次玻璃体内注射地塞米松植入剂后6个月内的安全性指标和最佳视力。
13例患者的15只眼中，在低眼压情况下共进行了99次注射。所有病例治疗后葡萄膜炎性黄斑囊样水肿或糖尿病性黄斑水肿均减轻。注射过程中未观察到并发症。注射后2例患者出现3例并发症。1例患者注射后立即出现人工晶状体震颤和轻度玻璃体出血，另1例患者出现延迟性玻璃体出血伴色素释放。所有3例并发症均未经干预而缓解。本研究的主要终点指标——平均视力在随访期间保持稳定。在随访期间眼压恢复正常的低眼压患者中，这归因于青光眼手术相关并发症的处理，而非玻璃体内地塞米松植入剂的作用。
对于合并低眼压且临床检查结果需要使用缓释玻璃体内类固醇植入剂治疗的患者，玻璃体内注射地塞米松植入剂是一种合理的治疗选择。进一步的研究，包括对低眼压眼中玻璃体内注射地塞米松植入剂前后晶状体悬韧带的成像，可能有助于明确该手术对人工晶状体稳定性的风险。
