抗血管内皮生长因子抑制剂与激素玻璃体腔注射后急性眼内炎的临床转归比较。

CLINICAL OUTCOMES OF ACUTE ENDOPHTHALMITIS AFTER INTRAVITREAL DELIVERY OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS VERSUS STEROIDS.

机构信息

Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN.

Retina Consultants of Minnesota, Edina, MN; and.

出版信息

Retina. 2023 Jun 1;43(6):947-954. doi: 10.1097/IAE.0000000000003748.

DOI:10.1097/IAE.0000000000003748

PMID:36727783

Abstract

PURPOSE

To compare patients with acute endophthalmitis after intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors vs. steroids.

METHODS

Retrospective single-center, nonrandomized interventional study from 2013 to 2021.Patients underwent vitreous biopsy before initiating treatment and were divided into the following cohorts: (1) anti-VEGF managed medically (T&I-anti-VEGF), (2) anti-VEGF managed by immediate pars plana vitrectomy (PPV-anti-VEGF), and (3) steroid therapy and managed medically or by pars plana vitrectomy (steroid).

RESULTS

A total of 141 patients were analyzed. The steroid cohort demonstrated significantly worse presenting (median = 2.80 logarithm of the minimum angle of resolution [logMAR]; P ≤ 0.01) and final (median = 2.30 logMAR) best-corrected visual acuity compared with T&I-anti-VEGF (presenting: median = 2.00 logMAR; final: median = 0.40 logMAR) and pars plana vitrectomy-anti-VEGF cohorts (presenting: median = 2.30 logMAR; final: median = 0.48 logMAR). There was no significant ( P = 0.33) difference in the final best-corrected visual acuity between T&I-anti-VEGF and pars plana vitrectomy-anti-VEGF cohorts. There were no significant ( P ≥ 0.63) differences among cohorts in best-corrected visual acuity before acute endophthalmitis diagnosis (T&I-anti-VEGF: median = 0.40 logMAR; pars plana vitrectomy-anti-VEGF: median = 0.40 logMAR; steroid: median = 0.44 logMAR). Microbial cultures revealed similar profiles for all cohorts.

CONCLUSION

Acute endophthalmitis after intravitreal injection steroid therapy had worse outcomes compared with anti-VEGF therapy.

摘要

目的

比较玻璃体内注射血管内皮生长因子（VEGF）抑制剂与皮质类固醇治疗后发生急性眼内炎的患者。

方法

这是一项回顾性、单中心、非随机干预研究，时间为 2013 年至 2021 年。患者在开始治疗前进行玻璃体活检，并分为以下队列：（1）抗 VEGF 药物治疗（T&I-抗 VEGF），（2）立即行玻璃体切除术的抗 VEGF 治疗（PPV-抗 VEGF），和（3）皮质类固醇治疗和药物或玻璃体切除术治疗（皮质类固醇）。

结果

共分析了 141 例患者。与 T&I-抗 VEGF（表现：中位数=2.00 logMAR；最终：中位数=0.40 logMAR）和玻璃体切除术-抗 VEGF 队列（表现：中位数=2.30 logMAR；最终：中位数=0.48 logMAR）相比，皮质类固醇组的表现（中位数=2.80 最小分辨角对数[logMAR]；P≤0.01）和最终最佳矫正视力（中位数=2.30 logMAR）明显更差。T&I-抗 VEGF 和玻璃体切除术-抗 VEGF 两组最终最佳矫正视力无显著差异（P=0.33）。在急性眼内炎诊断前，各组最佳矫正视力无显著差异（T&I-抗 VEGF：中位数=0.40 logMAR；玻璃体切除术-抗 VEGF：中位数=0.40 logMAR；皮质类固醇：中位数=0.44 logMAR）（P≥0.63）。微生物培养显示所有队列的结果相似。