Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10,63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
BMC Ophthalmol. 2024 Jan 19;24(1):25. doi: 10.1186/s12886-024-03291-2.
Triamcinolone acetonide (TA) is administered as an intravitreal or posterior sub-Tenon's capsule injection, as treatment for diabetic macular edema (DME). The intravitreal use of TA is limited because commercially available triamcinolone acetonide contains benzyl alcohol, a neurotoxic preservative. Few studies have compared effects of preservative-free intravitreal TA (IVTA) and posterior sub-Tenon capsule TA (STTA) injections for DME. Thus, herein, we compared the effectiveness of preservative-free IVTA and STTA for treatment of bevacizumab-resistant DME.
In this retrospective cohort study, bevacizumab-resistant DME was defined as a lack of response to at least three consecutive intravitreal bevacizumab (IVB) injections. Changes in mean central macula thickness (CMT), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) between IVTA and STTA groups were compared at baseline and at 1, 2, and 3 months after treatment.
Forty eyes from 40 patients were included in this study. In the IVTA group, the mean CMT improved significantly from 400.2 ± 144.42 μm at baseline to 288.35 ± 151.74 μm at 3 months after treatment (p = 0.01). Similarly, in the STTA group, the mean CMT improved significantly from 446.65 ± 120.74 μm at baseline to 382.9 ± 113.58 μm at 3 months after treatment (p = 0.009). The mean BCVA of the IVTA group also showed improvement, decreasing from 0.75 ± 0.55 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.625 ± 0.50 logMAR at 3 months after treatment (p = 0.089). Similarly, the mean BCVA of the STTA group improved, from 0.6 ± 0.36 logMAR at baseline to 0.54 ± 0.35 logMAR at 3 months after treatment (p = 0.094).
Given that IVTA and STTA demonstrated statistically equivalent anatomical and functional effects in patients with bevacizumab-resistant DME, the less invasive STTA may be considered the preferred treatment approach for the management of bevacizumab-resistant DME.
Retrospectively registered.
曲安奈德（TA）作为玻璃体内或后Tenon 囊内注射剂，用于治疗糖尿病性黄斑水肿（DME）。由于市售的曲安奈德中含有苯甲醇，这是一种神经毒性防腐剂，因此限制了其在玻璃体内的使用。很少有研究比较过无防腐剂玻璃体内曲安奈德（IVTA）和后Tenon 囊内 TA（STTA）注射治疗 DME 的效果。因此，本文比较了无防腐剂 IVTA 和 STTA 治疗贝伐单抗耐药性 DME 的疗效。
本回顾性队列研究将贝伐单抗耐药性 DME 定义为至少连续 3 次玻璃体内注射贝伐单抗（IVB）治疗后无反应。比较 IVTA 和 STTA 组治疗前、治疗后 1、2 和 3 个月时的平均中央黄斑厚度（CMT）、最佳矫正视力（BCVA）和眼压（IOP）的变化。
本研究共纳入 40 例 40 眼患者。在 IVTA 组，治疗后 3 个月时，CMT 从基线时的 400.2±144.42μm 显著改善至 288.35±151.74μm（p=0.01）。同样，在 STTA 组，CMT 从基线时的 446.65±120.74μm 显著改善至 382.9±113.58μm（p=0.009）。IVTA 组的平均 BCVA 也有所改善，从基线时的 0.75±0.55 最小分辨角对数（logMAR）降至治疗后 3 个月时的 0.625±0.50 logMAR（p=0.089）。同样，STTA 组的平均 BCVA 也有所改善，从基线时的 0.6±0.36 logMAR 降至治疗后 3 个月时的 0.54±0.35 logMAR（p=0.094）。
鉴于 IVTA 和 STTA 在贝伐单抗耐药性 DME 患者中具有统计学等效的解剖学和功能效果，侵袭性较小的 STTA 可能是治疗贝伐单抗耐药性 DME 的首选方法。
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