离心浓缩玻璃体内曲安奈德混悬液：一种用于长期类固醇给药的廉价、简便且可行的替代方法。
Centrifuged-Concentrated Intravitreal Slurry Triamcinolone Acetonide: An Inexpensive, Easy, and Viable Alternative to Long-Term Steroid Delivery.
作者信息
Malinowski Susan M, Wasserman Jason Adam
机构信息
Retina Consultants of Michigan, Southfield, MI, USA.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
出版信息
J Vitreoretin Dis. 2020 Sep 2;5(1):15-31. doi: 10.1177/2474126420943417. eCollection 2021 Jan-Feb.
PURPOSE
This work reports the duration, safety, and viability of intravitreal slurry triamcinolone acetonide (TA; 1.0 mL of 40-mg/mL TA centrifuge concentrated into a 0.1-mL pellet) to treat cystoid macular edema (CME).
METHODS
A retrospective, consecutive review was conducted of patients undergoing intravitreal slurry TA injections, July 2009 to December 2018.
RESULTS
In 143 eyes of 120 patients, slurry TA resolved CME for a mean of 327.15 (SD = 213.11) days, or 10.76 (SD = 7.00) months, per intravitreal injection (n = 466). In 100 eyes requiring multiple injections (n = 423), mean duration was 270.95 (SD = 177.14) days, or 8.91 (SD = 5.82) months, between injections. In 43 single-injection eyes, duration was 749.30 (SD = 483.17) days, or 24.63 (SD = 15.88) months. Mean duration decreased from 337.89 (SD = 210.46) days, or 11.11 (SD = 6.92) months, in nonvitrectomized eyes to 279.74 (SD 179.63) days, or 9.20 (SD = 5.91) months, in vitrectomized eyes (n = 74 injections, = 2.24, = .014, 1-tailed). Central foveal thickness as shown on optical coherence tomography decreased by 173.89μ (SD = 147.56μ), from 459.16μ (SD = 47.14μ) to 285.27μ (SD = 77.27μ; = -25.31, < .001), within 43.41 days (SD = 36.86). Visual acuity improved from 20/100 (logMAR 0.70, SD = 0.33) to 20/74 (logMAR 0.57, SD = 0.31; SD = 0.21; = -11.01, < .001), within 33.98 (SD 24.98) days. Fifteen of 31 phakic eyes (48.39%) underwent cataract extraction. Fifty-seven eyes (39.86%) developed a steroid response (> 10 mm Hg increase from baseline) 94.79 days (SD = 85.52 days), or 3.11 (SD = 2.81) months, following injection.
CONCLUSIONS
A single injection of slurry TA lasted on average 10.76 months with significant improvement of CME and visual acuity. Adverse ocular effects were comparable to currently available, long-term, implantable steroids. Slurry TA appears to be an easily reproducible, safe, and cost-effective alternative to long-term intraocular steroid delivery.
目的
本研究报告玻璃体内曲安奈德混悬液（TA；1.0 mL 40 mg/mL 的 TA 经离心浓缩成 0.1 mL 沉淀）治疗黄斑囊样水肿（CME）的持续时间、安全性和有效性。
方法
对 2009 年 7 月至 2018 年 12 月期间接受玻璃体内 TA 混悬液注射的患者进行回顾性连续研究。
结果
在 120 例患者的 143 只眼中，TA 混悬液使 CME 消退，每次玻璃体内注射平均持续 327.15（标准差 = 213.11）天，即 10.76（标准差 = 7.00）个月（n = 466）。在 100 只需要多次注射的眼中（n = 423），两次注射之间的平均持续时间为 270.95（标准差 = 177.14）天，即 8.91（标准差 = 5.82）个月。在 43 只单次注射的眼中，持续时间为 749.30（标准差 = 483.17）天，即 24.63（标准差 = 15.88）个月。平均持续时间从未行玻璃体切割术的眼中的 337.89（标准差 = 210.46）天，即 11.11（标准差 = 6.92）个月，降至行玻璃体切割术的眼中的 279.74（标准差 179.63）天，即 9.20（标准差 = 5.91）个月（n = 74 次注射，t = 2.24，P = 0.014，单尾）。光学相干断层扫描显示，中央凹厚度在 43.41 天（标准差 = 36.86）内从 459.16μm（标准差 = 47.14μm）降至 285.27μm（标准差 = 77.27μm；t = -25.31，P < 0.001），下降了 173.89μm（标准差 = 147.56μm）。视力在 33.98（标准差 24.98）天内从 20/100（logMAR 0.70，标准差 = 0.33）提高到 20/74（logMAR 0.57，标准差 = 0.31；标准差 = 0.21；t = -11.01，P < 0.001）。31 只晶状体眼中有 15 只（48.39%）接受了白内障摘除术。57 只眼（39.86%）在注射后 94.79 天（标准差 = 85.52 天），即 3.11（标准差 = 2.81）个月出现类固醇反应（眼压较基线升高 > 10 mmHg）。
结论
单次注射 TA 混悬液平均持续 10.76 个月，CME 和视力有显著改善。眼部不良反应与目前可用的长效可植入类固醇相当。TA 混悬液似乎是一种易于重复、安全且经济有效的长期眼内类固醇给药替代方法。
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