Faes Livia, Mishra Amit V, Lipkova Veronika, Balaskas Konstantinos, Quek Chrystie, Hamilton Robin, Held Ulrike, Sim Dawn, Sivaprasad Sobha, Fu Dun Jack
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 9EL, UK.
Kings College London, London WC2R 2LS, UK.
J Clin Med. 2023 Jun 6;12(12):3878. doi: 10.3390/jcm12123878.
Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetes mellitus. Intravitreal dexamethasone is a treatment option for patients unsuitable for or non-responsive to anti-angiogenic agents.
To quantify visual and anatomical outcomes from an initial intravitreal dexamethasone injection over the expected 6-month period of dexamethasone release by the implant. Design and enrolment: This is a retrospective cohort study using electronic medical records of patients reviewed between 1 January 2012 and 1 April 2022.
A tertiary eye-care center in London, United Kingdom; Moorfields Eye Hospital National Healthcare System Foundation Trust.
The cohort comprised 418 adult patients with DME who received an initial treatment of 700 µg intravitreal dexamethasone in the study period. Of these, 240 patients met the inclusion criteria of ≥2 hospital visits following initial injection (≥1 beyond 6 months) and no previous ocular corticosteroid treatment or missing assessment at baseline.
EXPOSURE(S): Intravitreal dexamethasone implant (700 µg).
MAIN OUTCOME(S) AND MEASURE(S): Probability of a positive visual outcome, defined as ≥5 or ≥10 Early Treatment Diabetic Retinopathy Study (ETDRS)-letter gain after treatment when compared to baseline (Kaplan-Meier models).
From the initial intravitreal dexamethasone injection alone, we observed a >75% chance of gaining ≥5 ETDRS letters and >50% chance of gaining ≥10 ETDRS letters within 6 months. There was less than a 50% chance of sustaining either positive visual outcome beyond 4 months.
Most patients can be expected to have a positive visual outcome following an initial injection of dexamethasone implants that subsides within 4 months. Real-world re-treatment was observed to be delayed until after visual benefits were lost in half of the cohort. Further research will be needed to study the effects of delays in re-treatment.
糖尿病性黄斑水肿（DME）是糖尿病患者视力丧失的主要原因。玻璃体内注射地塞米松是不适用于抗血管生成药物或对其无反应的患者的一种治疗选择。
量化在植入物预期释放地塞米松的6个月期间内，首次玻璃体内注射地塞米松后的视力和解剖学结果。设计与入组：这是一项回顾性队列研究，使用了2012年1月1日至2022年4月1日期间接受复查的患者的电子病历。
英国伦敦的一家三级眼科护理中心；摩尔菲尔德眼科医院国民医疗服务体系基金会信托医院。
该队列包括418名患有DME的成年患者，他们在研究期间接受了700μg玻璃体内地塞米松的初始治疗。其中，240名患者符合纳入标准，即初次注射后至少有2次医院就诊（6个月后至少1次），且既往未接受过眼部皮质类固醇治疗或基线评估缺失。
玻璃体内地塞米松植入物（700μg）。
与基线相比，治疗后早期糖尿病性视网膜病变研究（ETDRS）字母增加≥5或≥10定义为视力改善的概率（Kaplan-Meier模型）。
仅通过首次玻璃体内注射地塞米松，我们观察到在6个月内获得≥5个ETDRS字母的概率>75%，获得≥10个ETDRS字母的概率>50%。在4个月后维持任何一种视力改善结果的概率均小于50%。
大多数患者在首次注射地塞米松植入物后可预期获得视力改善结果，且该结果在4个月内消退。在现实世界中，再次治疗被观察到会延迟，直到队列中一半的患者视力益处丧失之后。需要进一步研究以探讨再次治疗延迟的影响。
