Tariq Farheen, Wang Yanfen, Ma Bo, He Yidan, Zhang Shu, Bai Ling
Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Ophthalmology, The No.4 Hospital of Xi'an, Xi'an, China.
Front Med (Lausanne). 2022 Feb 16;9:777549. doi: 10.3389/fmed.2022.777549. eCollection 2022.
To compare the visual and morphological effects between intravitreal injection of filtered modified 2 mg triamcinolone acetonide (TA) and 0. 5 mg ranibizumab in patients with pseudophakic cystoid macular edema (PCME).
A retrospective, interventional study was conducted from January 2015 to February 2020 involving patients with PCME after uneventful cataract surgery. A total of 25 patients (25 eyes) with PCME received an intravitreal injection of 0.22 μm filtered modified 2 mg TA, while 15 patients (15 eyes) received 0.5 mg ranibizumab injection. Central macular thickness (CMT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), times of repeated injections, and other side effects were observed at 2 weeks, 1 month, 3 months, and 6 months after injection; then, the data were compared with preinjection information in each group and between the two groups.
Both the TA and ranibizumab intravitreal injection can achieve improved BCVA and reduced CMT in patients with PCME ( < 0.05), with a trend toward greater improvement in the TA group, but the difference was only significant at 3 months ( < 0.05). IOP was in the normal range without any significant difference ( > 0.05). Thirty-three percent of patients in the ranibizumab group required repeated intravitreal injection compared to 4% in the TA group. Further stratified analysis showed that the better therapeutic effect of the TA group at 3 months after injection only existed in patients with diabetes mellitus (DM), while not in patients without DM. There was no repeat injection in the TA group and 12.5% in the ranibizumab group for patients without DM, while 16.7% in the TA group and 57.1% in the ranibizumab group required repeated injection for patients with DM, which had a significant difference ( < 0.05).
Intravitreal injection of filtered modified 2 mg TA is safe, effective, and an inexpensive alternative to antivascular endothelial growth factor (anti-VEGF) agents for patients with PCME, especially for patients concurrently with DM. A large number of clinical randomized controlled studies along with long-term follow-up observations are needed.
比较玻璃体腔内注射经滤过的改良2mg曲安奈德（TA）与0.5mg雷珠单抗对人工晶状体眼黄斑囊样水肿（PCME）患者的视觉和形态学影响。
对2015年1月至2020年2月期间行白内障手术顺利后发生PCME的患者进行一项回顾性干预研究。共有25例（25只眼）PCME患者接受了玻璃体腔内注射经0.22μm滤过的改良2mg TA，15例（15只眼）患者接受了0.5mg雷珠单抗注射。在注射后2周、1个月、3个月和6个月观察中心黄斑厚度（CMT）、最佳矫正视力（BCVA）、眼压（IOP）、重复注射次数及其他副作用；然后将数据与每组注射前信息及两组间信息进行比较。
TA和雷珠单抗玻璃体腔内注射均可使PCME患者的BCVA提高、CMT降低（P<0.05），TA组改善趋势更大，但仅在3个月时差异有统计学意义（P<0.05）。IOP在正常范围内，无显著差异（P>0.05）。雷珠单抗组33%的患者需要重复玻璃体腔内注射，而TA组为4%。进一步分层分析显示，TA组在注射后3个月的较好治疗效果仅存在于糖尿病（DM）患者中，而非DM患者中不存在。非DM患者TA组无重复注射，雷珠单抗组为12.5%；DM患者TA组为16.7%，雷珠单抗组为57.1%，差异有统计学意义（P<0.05）。
玻璃体腔内注射经滤过的改良2mg TA对PCME患者安全有效且是抗血管内皮生长因子（抗VEGF）药物的廉价替代方案，尤其适用于合并DM的患者。需要大量临床随机对照研究及长期随访观察。
