MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal; RISE-Health Research Network, Porto, Portugal.
Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Surv Ophthalmol. 2022 Jul-Aug;67(4):991-1013. doi: 10.1016/j.survophthal.2021.12.002. Epub 2021 Dec 9.
Uveitis is among the leading causes of visual loss in the working age population. In noninfectious uveitis, corticosteroids are the first line therapy. We sought to review systematically the evidence regarding the regional corticosteroid delivery modalities in the treatment of noninfectious uveitis. A 5-database search (Pubmed, ISI Web of Science, Cochrane, ClinicalTrials.gov, and Scopus) was performed from inception to February, 2021. Nineteen studies with a total of 1,935 eyes of 1,753 patients were selected from 8,922 abstracts retrieved by the initial search. The most frequently compared regimens were intravitreal triamcinolone acetonide injection and orbital floor triamcinolone acetonide injection (2 studies), intravitreal triamcinolone acetonide injection and posterior sub-Tenon triamcinolone acetonide injection (2 studies), and posterior sub-Tenon triamcinolone acetonide injection with the intravitreal dexamethasone implant (2 studies). Our results show that the intravitreal injection of corticosteroids is more effective, but is associated with more adverse events, than periocular injection. Some evidence supports the use of subconjunctival triamcinolone acetonide over intravitreal/periocular triamcinolone acetonide. Moreover, the overall results of 0.59 mg dosage of the intravitreal fluocinolone acetonide implant were superior to those from the 2.1 mg dose. The evidence, however, is not robust, and further studies with standardized outcomes are warranted.
葡萄膜炎是导致工作年龄人群视力丧失的主要原因之一。在非感染性葡萄膜炎中，皮质类固醇是一线治疗药物。我们旨在系统回顾有关皮质类固醇局部给药方式治疗非感染性葡萄膜炎的证据。从最初开始到 2021 年 2 月，我们在 5 个数据库（Pubmed、ISI Web of Science、Cochrane、ClinicalTrials.gov 和 Scopus）中进行了搜索。从最初检索到的 8922 篇摘要中，共选择了 19 项研究，共有 1753 名患者的 1935 只眼。最常比较的方案是玻璃体内曲安奈德注射和眼眶底部曲安奈德注射（2 项研究）、玻璃体内曲安奈德注射和后Tenon 下曲安奈德注射（2 项研究），以及后Tenon 下曲安奈德注射联合玻璃体内地塞米松植入物（2 项研究）。我们的研究结果表明，与眼周注射相比，皮质类固醇玻璃体内注射更有效，但与更多的不良反应相关。一些证据支持使用结膜下曲安奈德而非玻璃体内/眼周曲安奈德。此外，玻璃体内氟轻松醋酸盐植入物 0.59mg 剂量的总体结果优于 2.1mg 剂量。然而，证据并不充分，需要进一步进行标准化结局的研究。
