386696Hospital La Croix-Rousse Ophthalmology, Lyon, Rhône-Alpes, France.
Department of Ophthalmology, 37045Centre Hospitalier Universitaire de Nice, Nice, France.
Eur J Ophthalmol. 2022 Sep;32(5):2845-2856. doi: 10.1177/11206721211052852. Epub 2021 Nov 13.
The intravitreal dexamethasone implant (DEX-I) is an alternative to anti-VEGF for the first-line treatment of diabetic macular oedema (DME). However, several questions remain regarding its routine use and its place in certain situations not always specified in current recommendations. A national consensus approach was, therefore, initiated by French retinal experts.
An iterative Delphi consensus approach was used. A steering committee (SC) of seven experts analysed data from the literature to formulate statements divided into five key areas of treatment. These statements were submitted to the independent and anonymous electronic vote of 87 French retina experts among whom 39 expressed their opinion and therefore constituted the voting panel.
After two rounds of voting, 22 and 7 of 38 statements received a strong consensus and a good consensus, respectively. The consensus level was higher for statements regarding first-line indications and safety of DEX-I compared to those regarding efficacy assessment, reprocessing time or pathophysiological biomarkers. The panellists recommended the preferential use of DEX-I for patients with limited availability for multiple injections, those who needed to undergo cataract surgery or who had a recent cardiovascular history, and as a therapeutic alternative to anti-VEGF in patients with a history of vitrectomy, retinal serous detachment, hyper-reflective points or dry exudates in optical coherence tomography (OCT). However, some statements proposed by SC experts were not validated.
This study provides some key recommendations to clinicians treating diabetic macular oedema, which may be useful when using intravitreal dexamethasone implants in daily practice.
玻璃体内注射地塞米松植入物（DEX-I）是抗血管内皮生长因子药物治疗糖尿病黄斑水肿（DME）的一线选择。然而，在常规使用方面，以及在某些情况下的应用，仍存在一些问题，而这些情况在当前的推荐中并未明确说明。因此，法国视网膜专家发起了一项全国性的共识方法。
采用迭代 Delphi 共识方法。一个由 7 名专家组成的指导委员会（SC）分析文献中的数据，制定了分为五个治疗关键领域的陈述。这些陈述提交给 87 名法国视网膜专家进行独立和匿名的电子投票，其中 39 名专家表达了意见，因此构成了投票小组。
经过两轮投票，38 项陈述中有 22 项和 7 项分别获得强烈共识和良好共识。在 DEX-I 的一线适应证和安全性方面的陈述，其共识水平高于在疗效评估、再处理时间或病理生理生物标志物方面的陈述。专家组建议优先考虑将 DEX-I 用于那些多次注射机会有限、需要接受白内障手术或近期有心血管病史的患者，以及作为玻璃体切割术、视网膜浆液性脱离、光学相干断层扫描（OCT）中高反射点或干性渗出物史患者的抗血管内皮生长因子治疗的替代选择。然而，SC 专家提出的一些陈述未得到验证。
本研究为治疗糖尿病黄斑水肿的临床医生提供了一些关键建议，在日常实践中使用玻璃体内注射地塞米松植入物时可能会有所帮助。
