Augustin Albert J, Feltgen Nicolas, Haritoglou Christos, Hoerauf Hans, Maier Mathias M, Mardin Christian Yahya, Schargus Marc
Augenklinik, Klinikum Karlsruhe.
Augenklinik, Universitätsmedizin Göttingen.
Klin Monbl Augenheilkd. 2021 Jan;238(1):73-84. doi: 10.1055/a-1024-4089. Epub 2019 Nov 26.
Currently two intravitreally applied corticosteroids (dexamethasone and fluocinolone) are licensed in Germany for treatment of diabetic macular oedema (DME). The use of DEX implant for DME in daily clinical practice has not been defined in detail. Following a Delphi panel survey, a group of retina experts set out to come up with a consensus for use of the DEX implant in DME.
International and national treatment recommendations were identified from the literature. A steering group generated a catalogue of 72 statements on the aetiology and pathogenesis of DME, therapy with DEX implant, use of DEX implant in patients previously treated with VEGF-inhibitors, use of DEX implant in combination therapy, safety of DME therapies as well as patients' burden of treatment. Twenty-two ophthalmologists from private practice and 6 hospital ophthalmologists participated in the Delphi panel via Survey Monkey. Consensus was reached if at least 75% of participants agreed or disagreed with a statement. Statements for which consensus was not reached were discussed once more during the expert consensus meeting and a vote was taken. Based on these results a treatment algorithm for foveal DME was proposed.
If a patient does not show sufficient response after 3 - 6 months of anti-VEGF treatment (visual acuity gain of < 5 ETDRS letters or reduction of central retinal thickness ≤ 20%), a switch to DEX implant should take place. DEX implant is also suitable in eyes with longer presentation of DME, showing e.g. massive lipid exudates. DEX implant is suitable as first-line therapy especially in pseudophakic patients, patients unwilling or able to comply with tight anti-VEGF injection intervals or patients with known vascular diseases. With fixed control visits every 4 - 8 weeks, use of DEX implant is flexible and individual. Decision parameters for repeated use should be visual acuity, retinal thickness and intraocular pressure. Treatment of both eyes on the same day should not take place.
The algorithm presented reflects survey as well as expert discussion results and may differ from recommendations issued by the German professional society. The consensus recommendations for the treatment of DME generated during the survey and meeting of retina experts are intended to guide use of DEX implant in daily practice.
目前在德国，两种玻璃体内注射用皮质类固醇（地塞米松和氟轻松）被批准用于治疗糖尿病性黄斑水肿（DME）。在日常临床实践中，DEX植入物用于DME的使用方法尚未详细界定。在一次德尔菲专家小组调查之后，一组视网膜专家着手就DEX植入物在DME中的使用达成共识。
从文献中确定国际和国内的治疗建议。一个指导小组编制了一份包含72条声明的目录，内容涉及DME的病因和发病机制、DEX植入物治疗、DEX植入物在先前接受过VEGF抑制剂治疗的患者中的使用、DEX植入物在联合治疗中的使用、DME治疗的安全性以及患者的治疗负担。22名私人执业眼科医生和6名医院眼科医生通过Survey Monkey参与了德尔菲专家小组。如果至少75%的参与者同意或不同意某条声明，则达成共识。未达成共识的声明在专家共识会议上再次进行讨论并进行投票。基于这些结果，提出了一种针对黄斑中心凹DME的治疗算法。
如果患者在抗VEGF治疗3 - 6个月后没有显示出足够的反应（视力提高<5个ETDRS字母或中心视网膜厚度减少≤20%），则应改用DEX植入物。DEX植入物也适用于DME病程较长的眼睛，例如出现大量脂质渗出的眼睛。DEX植入物适合作为一线治疗，尤其适用于人工晶状体眼患者、不愿意或无法遵守严格抗VEGF注射间隔的患者或患有已知血管疾病的患者。每4 - 8周进行定期的对照检查，DEX植入物的使用灵活且个体化。重复使用的决策参数应为视力、视网膜厚度和眼压。同一天不应治疗双眼。
所提出的算法反映了调查以及专家讨论结果，可能与德国专业协会发布的建议有所不同。在视网膜专家调查和会议期间产生的DME治疗共识建议旨在指导DEX植入物在日常实践中的使用。
