Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France.
Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.
Ophthalmologica. 2022;245(4):350-357. doi: 10.1159/000519235. Epub 2021 Sep 29.
The aim of this study was to describe the outcomes of a switch back to anti-vascular endothelial growth factor (VEGF) in diabetic macular oedema (DME) eyes treated temporarily with a dexamethasone implant (DEXi), after an initial poor response to anti-VEGF.
The study involved a case series.
Twenty-three eyes of 17 patients were included. All were poorly responsive to anti-VEGF and switched to a DEXi after a mean of 12 anti-VEGF injections. The mean best-corrected visual acuity (BCVA) increased from 0.25 ± 0.19 (decimals) to 0.29 ± 0.20 after switching to the DEXi (p = 0.11). BCVA remained stable (0.31 ± 0.23; p = 0.11) after switching back to anti-VEGF, one month after the last injection. The mean central macular thickness (CMT) decreased significantly from 517.0 ± 128.5 μm to 343.4 ± 118.9 μm (p < 0.001) after switching to the DEXi. In eyes receiving ≥3 anti-VEGF injections during the switch back, the CMT 1 month after the last anti-VEGF injection was significantly decreased compared to the CMT before the switch to the DEXi (mean change of - 95.55 ± 89.82 μm, p = 0.005).
Switching back poorly responsive DME eyes to anti-VEGF after temporary DEXi therapy is associated with good anatomical and visual outcomes similar to those obtained with the DEXi, provided that at least 3 anti-VEGF injections are administered. The DEXi might restore retinal sensitivity to anti-VEGF.
本研究旨在描述在对初始抗血管内皮生长因子（VEGF）治疗反应不佳的糖尿病黄斑水肿（DME）眼中，暂时改用地塞米松植入剂（DEXi）后，重新使用抗 VEGF 的结果。
本研究为病例系列研究。
共纳入 17 名患者的 23 只眼。所有患者均对抗 VEGF 治疗反应不佳，在接受平均 12 次抗 VEGF 注射后，改用 DEXi。改用 DEXi 后，平均最佳矫正视力（BCVA）从 0.25 ± 0.19（小数）增加到 0.29 ± 0.20（p = 0.11）。在最后一次注射一个月后，重新使用抗 VEGF 后，BCVA 保持稳定（0.31 ± 0.23；p = 0.11）。改用 DEXi 后，平均中央黄斑厚度（CMT）从 517.0 ± 128.5 μm 显著降低至 343.4 ± 118.9 μm（p < 0.001）。在重新使用抗 VEGF 的过程中接受了≥3 次抗 VEGF 注射的眼中，与改用 DEXi 前相比，最后一次抗 VEGF 注射后 1 个月的 CMT 显著降低（平均变化 - 95.55 ± 89.82 μm，p = 0.005）。
在 DEXi 临时治疗后，对反应不佳的 DME 眼重新使用抗 VEGF，与使用 DEXi 获得的解剖和视觉结果相似，前提是至少给予 3 次抗 VEGF 注射。DEXi 可能会恢复视网膜对抗 VEGF 的敏感性。
