Department of General Surgery, St Vincent's Hospital, Sydney, Victoria, Australia.
University of New South Wales, Sydney, New South Wales, Australia.
Clin Exp Ophthalmol. 2019 Dec;47(9):1156-1163. doi: 10.1111/ceo.13611. Epub 2019 Aug 27.
Inflammatory-mediated cystoid macular oedema (CMO) is the most common inflammatory-mediated threat to vision in non-infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained-release dexamethasone (DEX) implant devices provide localized therapy.
The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort.
A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital.
Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies.
Cases from March 2012 and March 2018 were retrospectively selected with follow-up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow-up was 32 weeks.
The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure and medication regimens.
Ninety-five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P < .01). Sixty-one percent demonstrated improved BCVA at week 8 (P < .05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low.
In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort.
炎症介导的囊样黄斑水肿（CMO）是非感染性葡萄膜炎（NIU）中最常见的炎症介导的视力威胁。皮质类固醇治疗是 NIU 中 CMO 管理的基石。缓释地塞米松（DEX）植入物提供局部治疗。
作者报告了一系列在澳大利亚队列中记录 DEX 植入物治疗 NIU 疗效的病例。
单中心、回顾性病例系列研究，在新南威尔士州的一家三级眼科医院对 2012 年至 2018 年期间因 NIU 接受 DEX 植入物治疗的患者进行研究。
17 例患者的 20 只眼因各种病因接受 DEX 植入物治疗确诊的 NIU。
从 2012 年 3 月和 2018 年 3 月回顾性选择病例，记录和分析随访评估数据。所有患者在植入后 1、2 和 4 周以及每月接受一次检查。随访时间至少为 32 周。
主要观察指标为两次连续就诊时中央视网膜厚度（CRT）增加超过 20%。次要观察指标包括最佳矫正视力（BCVA）、眼压和药物治疗方案的变化。
95%的患者在 4、8 和 16 周时 CRT 显著降低（P<0.01）。61%的患者在 8 周时视力改善（P<0.05）。开始时接受全身皮质类固醇治疗的 90%患者将其剂量减少到 7.5 毫克/天以下。不良事件的频率较低。
与较大的研究一致，作者认为 DEX 植入物可能有效地控制对其他治疗有抗药性的葡萄膜炎，同时改善 BCVA 和 CRT。此外，DEX 的使用在观察到的队列中明显降低了全身类固醇的负担。
