Augustin Albert J, Bopp Silvia, Fechner Martin, Holz Frank G, Sandner Dirk, Winkgen Andrea-M, Khoramnia Ramin, Neuhann Thomas, Warscher Markus, Spitzer Martin S, Sekundo Walter, Seitz Berthold, Duncker Tobias, Ksinsik Christian, Höh Helmut
Augenklinik, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany.
Augenklinik Universitätsallee, Bremen, Germany.
Eur J Ophthalmol. 2021 May 4:11206721211014728. doi: 10.1177/11206721211014728.
There is a lack of consensus on the use of intravitreal corticosteroid therapies in patients with diabetic macular edema (DME) and prior vitrectomized eyes in clinical practice.
Retro-IDEAL was a 3-year retrospective, multicenter study in patients with chronic DME (i.e. DME that persists or recurs despite treatment) treated with ILUVIEN (0.2 µg daily fluocinolone acetonide intravitreal implant), who had suboptimal outcomes with first-line vascular endothelial growth-factor inhibitors and other DME therapies.
A total of 81 eyes (63 patients) were included of which 39 eyes had undergone prior vitrectomy (PV group) while 42 eyes had not undergone prior vitrectomy (NPV). Baseline characteristics were balanced; however, more patients had proliferative diabetic retinopathy in the PV group vs. the NPV group (21.62% vs 9.38%, respectively). Over 36 months, mean visual acuity (VA) increased in both groups with a tendency for more ETDRS letters being gained in the NPV group (+5.33) vs. the PV group (+2.42). By month 36, central retinal thickness was reduced to ⩽300 µm in two-thirds of the eyes in both groups and the mean change from baseline in intraocular pressure was similar in both groups (+0.50 mmHg -0.75 mmHg; NPV and PV group).
These long-term data suggest that the 0.2 μg/day FAc implant is effective in both vitrectomized and non-vitrectomized patients, with a manageable safety profile, and improved VA and reduced supplemental therapies for patients with a suboptimal response to first-line DME therapies. Clinicians may consider utilizing the FAc implant earlier in the DME disease process.
在临床实践中，对于糖尿病性黄斑水肿（DME）患者以及既往接受过玻璃体切割术的眼睛使用玻璃体内皮质类固醇疗法，目前尚无共识。
Retro-IDEAL是一项为期3年的回顾性多中心研究，研究对象为患有慢性DME（即尽管接受治疗仍持续或复发的DME）且一线血管内皮生长因子抑制剂和其他DME疗法效果欠佳，接受ILUVIEN（每日0.2μg醋酸氟轻松玻璃体内植入剂）治疗的患者。
共纳入81只眼（63例患者），其中39只眼既往接受过玻璃体切割术（PV组），42只眼未接受过玻璃体切割术（NPV组）。基线特征均衡；然而，PV组增殖性糖尿病视网膜病变患者比NPV组更多（分别为21.62%和9.38%）。在36个月期间，两组的平均视力（VA）均有所提高，NPV组（增加5.33个字母）比PV组（增加2.42个字母）获得更多ETDRS字母的趋势更明显。到第36个月时，两组三分之二的眼睛中心视网膜厚度降至≤300μm，两组眼内压相对于基线的平均变化相似（NPV组和PV组分别为+0.50mmHg和-0.75mmHg）。
这些长期数据表明，每日0.2μg醋酸氟轻松植入剂对接受过玻璃体切割术和未接受过玻璃体切割术的患者均有效，安全性可控，对于一线DME疗法反应欠佳的患者，可改善视力并减少补充治疗。临床医生可考虑在DME疾病过程中更早地使用醋酸氟轻松植入剂。
