Chakraborty Somnath, Ganguly Santanu, Sheth Jay Umed
Department of Vitreoretinal Services, Retina Institute of Bengal, Siliguri, India.
Department of Anterior Segment Services, Retina Institute of Bengal, Siliguri, India.
Clin Ophthalmol. 2024 Jan 23;18:227-233. doi: 10.2147/OPTH.S449250. eCollection 2024.
Diabetic macular edema (DME) is a significant cause of vision impairment, posing challenges in its management due to variable responses and patient diversity. While anti-vascular endothelial growth factor (anti-VEGF) agents have revolutionized DME treatment, some patients are not suitable candidates for this therapy. Intravitreal corticosteroid therapy, such as the dexamethasone implant (DEX), has emerged as an alternative. This study aimed to comprehensively investigate the role of intravitreal DEX in treatment-naive DME patients with systemic contraindications to anti-VEGF therapy, administered one month before cataract surgery.
A single-center retrospective study included 20 eyes with controlled diabetes, visually significant cataracts, untreated DME, and systemic contraindications for anti-VEGF therapy. Patients underwent DEX treatment followed by cataract surgery after one month. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were assessed at multiple time points.
BCVA significantly improved on days 30, 90, and 180 post-DEX (<0.00001). CMT showed a significant decrease at day 30 (<0.00001), which was sustained through days 90 and 180 (<0.00001). Recurrent DME was observed in 25% of eyes on day 90. IOP increased significantly at days 30 (<0.00001) and 90 (=0.0006), returning to baseline by day 180. However, only two eyes needed topical anti-glaucoma treatment. No other ocular or systemic adverse events were noted.
Intravitreal DEX administered one month before cataract surgery offers a promising treatment strategy for treatment-naive DME patients with systemic contraindications to anti-VEGF therapy. The study's findings provide insights into improving visual acuity and reducing macular thickness, along with manageable IOP changes. This personalized approach is a valuable addition to DME management, especially for complex medical cases, warranting further research and consideration for clinical practice.
糖尿病性黄斑水肿（DME）是视力损害的一个重要原因，由于反应的变异性和患者的多样性，其管理面临挑战。虽然抗血管内皮生长因子（anti-VEGF）药物彻底改变了DME的治疗方式，但一些患者并不适合这种治疗。玻璃体内注射皮质类固醇疗法，如地塞米松植入物（DEX），已成为一种替代方法。本研究旨在全面调查玻璃体内注射DEX在患有抗VEGF治疗全身性禁忌证的初治DME患者中的作用，在白内障手术前一个月进行给药。
一项单中心回顾性研究纳入了20只眼睛，这些眼睛患有控制良好的糖尿病、具有视觉意义的白内障、未治疗的DME以及抗VEGF治疗的全身性禁忌证。患者接受DEX治疗，一个月后进行白内障手术。在多个时间点评估最佳矫正视力（BCVA）、中心黄斑厚度（CMT）和眼压（IOP）。
在DEX注射后第30、90和180天，BCVA显著改善（<0.00001）。CMT在第30天显著降低（<0.00001），并在第90天和180天持续降低（<0.00001）。在第90天，25%的眼睛观察到复发性DME。IOP在第30天（<0.00001）和第90天（=0.0006）显著升高，到第180天恢复到基线水平。然而，只有两只眼睛需要局部抗青光眼治疗。未观察到其他眼部或全身性不良事件。
在白内障手术前一个月给予玻璃体内DEX，为患有抗VEGF治疗全身性禁忌证的初治DME患者提供了一种有前景的治疗策略。该研究结果为提高视力、减少黄斑厚度以及可控制的IOP变化提供了见解。这种个性化方法是DME管理中的一项有价值的补充，特别是对于复杂的医疗病例，值得进一步研究并考虑应用于临床实践。
