Rezkallah Amina, Kodjikian Laurent, Barbarroux Aymeric, Laventure Corentin, Motreff Antoine, Chacun Samuel, Matonti Frédéric, Denis Philippe, Mathis Thibaud
Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France.
UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France.
Pharmaceutics. 2022 Aug 23;14(9):1756. doi: 10.3390/pharmaceutics14091756.
Patients with both macular edemas, of various etiologies such as diabetes and glaucoma, may suffer serious loss of vision if either disease goes untreated. Where no effective alternative therapies are available, dexamethasone implant (DEX-I) injections may be the only choice of treatment, despite the risk of a possible increase in intraocular pressure (IOP) when using steroids. Although many studies have reported on IOP evolution in eyes treated with DEX-I, little is known specifically about eyes with a history of filtering surgery. The aim of this observational series was to evaluate the IOP response following DEX-I injection in eyes presenting conventional filtering surgeries or microinvasive glaucoma surgeries (MIGS). Twenty-five eyes were included in this study. A total of 64% of the eyes did not experience OHT during follow-up. Additional IOP-lowering therapy was needed for 32% of eyes, and 20% of eyes (all showing bleb fibrosis) required further filtering surgery: 50% of eyes in the MIGS group and 10.5% of eyes in the conventional filtering surgery group. A significant positive correlation was found between IOP at baseline and the maximum IOP throughout follow-ups after DEX-I (r = 0.45, = 0.02). In conclusion, if DEX-I is used when there are no alternative therapies for treating macular edema, IOP in eyes with a history of filtering surgery is generally manageable. Those eyes which previously underwent conventional therapy with effective blebs obtained better IOP control after DEX-I injections and mostly did not require any additional IOP-lowering therapy or surgery.
患有各种病因（如糖尿病和青光眼）引起的黄斑水肿的患者，如果任何一种疾病得不到治疗，都可能会严重丧失视力。在没有有效的替代疗法的情况下，地塞米松植入物（DEX-I）注射可能是唯一的治疗选择，尽管使用类固醇时存在眼压（IOP）可能升高的风险。尽管许多研究报告了接受DEX-I治疗的眼睛的眼压变化，但对于有滤过手术史的眼睛具体情况知之甚少。本观察系列的目的是评估在接受传统滤过手术或微创青光眼手术（MIGS）的眼睛中注射DEX-I后的眼压反应。本研究纳入了25只眼睛。在随访期间，共有64%的眼睛未发生高眼压。32%的眼睛需要额外的降眼压治疗，20%的眼睛（均显示滤过泡纤维化）需要进一步的滤过手术：MIGS组中有50%的眼睛，传统滤过手术组中有10.5%的眼睛。在基线眼压与DEX-I注射后整个随访期间的最高眼压之间发现了显著的正相关（r = 0.45，P = 0.02）。总之，如果在没有治疗黄斑水肿的替代疗法时使用DEX-I，有滤过手术史的眼睛的眼压通常是可控的。那些先前接受过传统治疗且获得有效滤过泡的眼睛在注射DEX-I后眼压控制得更好，并且大多不需要任何额外的降眼压治疗或手术。
