Khomyakova E N, Ryabtseva A A, Sergushev S G, Grishina E E
Moscow Regional Research and Clinical Institute, 61/2-11 Shchepkina St., Moscow, Russian Federation, 129110.
State Research Center Burnasyan Federal Medical Biophysical Center of the Federal Medical-Biological Agency, 15 Gamalei St., Moscow, Russian Federation, 123098.
Vestn Oftalmol. 2019;135(6):67-72. doi: 10.17116/oftalma201913506167.
Diabetic macular edema (DME) is a serious complication of diabetic retinopathy. Numerous multicenter studies of the effectiveness of various treatment methods for DME do not give unambiguous recommendations for the treatment of refractory DME, and combinations of various forms of therapy continue to be actively studied.
To study the effectiveness of the combination of intravitreal administration of the drug Ozurdex with subsequent individually selected laser therapy in the treatment of the proliferative stage of diabetic retinopathy in patients with concomitant chronic DME, and its relationship with morphological changes in the retina observed with optical coherence tomography.
This retrospective study included 18 patients with insulin-requiring type II diabetes mellitus complicated by diabetic retinopathy in the proliferative stage and refractory DME. According to morphological changes observed with optical coherence tomography of the retina, the patients were divided into 3 groups: 6 patients with diffuse macular edema, 6 patients with cystic macular edema, and 6 patients with serous detachment of the retinal neuroepithelium. All patients underwent intravitreal injection of 0.7 mg Ozurdex followed by panretinal laser coagulation. The choice of laser applicates with the minimal parameters giving a therapeutic effect was carried out according to the procedure described previously (Patent No. RU2611887C1 d.d. 12/25/2015).
The combination of intravitreal administration of Ozurdex followed by individually selected laser coagulation is effective against various morphological types of DME. However, the greatest visual acuity was achieved in patients with diffuse macular edema and retinal neuroepithelial detachment.
The higher the initial visual acuity, the better the functional outcomes of the treatment. Baseline retinal thickness did not affect the effectiveness of the proposed method of treatment. Cystic macular edema was an unfavorable prognostic factor for improving visual acuity.
糖尿病性黄斑水肿（DME）是糖尿病视网膜病变的一种严重并发症。众多关于DME各种治疗方法有效性的多中心研究并未给出针对难治性DME治疗的明确建议，各种治疗形式的联合仍在积极研究中。
研究玻璃体内注射Ozurdex药物并随后进行个体化选择的激光治疗相结合，在伴有慢性DME的糖尿病视网膜病变增殖期患者治疗中的有效性，以及其与光学相干断层扫描观察到的视网膜形态学变化的关系。
这项回顾性研究纳入了18例需要胰岛素治疗的II型糖尿病患者，其合并增殖期糖尿病视网膜病变和难治性DME。根据视网膜光学相干断层扫描观察到的形态学变化，将患者分为3组：6例弥漫性黄斑水肿患者，6例囊样黄斑水肿患者，6例视网膜神经上皮浆液性脱离患者。所有患者均接受了0.7mg Ozurdex的玻璃体内注射，随后进行全视网膜激光光凝。根据先前描述的程序（专利号RU2611887C1，2015年12月25日）选择具有最小参数且能产生治疗效果的激光照射器。
玻璃体内注射Ozurdex随后进行个体化选择的激光光凝相结合，对各种形态类型的DME有效。然而，弥漫性黄斑水肿和视网膜神经上皮脱离患者的视力提高最为显著。
初始视力越高，治疗的功能结果越好。基线视网膜厚度不影响所提出治疗方法的有效性。囊样黄斑水肿是视力改善的不利预后因素。
