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用于治疗葡萄膜炎性黄斑水肿的皮质类固醇:全面综述

Corticosteroids for the Management of Uveitic Macular Edema: A Comprehensive Review.

作者信息

Jimenez Yanny Perez, Neri Piergiorgio, Al Ali Sahar, Aljneibi Shaikha, Aldhanhani Aishah, Al Masri Khaled, Agarwal Aniruddha, Pichi Francesco

机构信息

Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.

Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

出版信息

Ocul Immunol Inflamm. 2025 Sep;33(7):1385-1398. doi: 10.1080/09273948.2024.2395289. Epub 2024 Sep 5.

Abstract

Uveitis, which refers to the inflammation of the uveal tract and surrounding structures in the eye, poses a significant risk of vision impairment, with macular edema (UME) being a prevalent complication. The current statement reviews UME's prevalence, pathogenesis, diagnosis, and management strategies, focusing on the utility of systemic and local corticosteroid therapy. Corticosteroids, with their multifaceted effects on inflammatory pathways, serve as the cornerstone of UME treatment. Various administration routes, including topical, periocular, intraocular, and systemic, are employed based on the anatomical type and severity of inflammation. The efficacy of different corticosteroid formulations, such as difluprednate, triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant, is evaluated through clinical trials and retrospective studies. Additionally, the role of corticosteroid-sparing treatments, including antimetabolites like methotrexate and mycophenolate mofetil, is explored. Emerging techniques, such as suprachoroidal space triamcinolone acetonide administration, offer promising alternatives for managing UME. Through a thorough examination of current evidence, this review provides valuable insights into optimizing the management of UME and improving visual outcomes in patients with uveitis.

摘要

葡萄膜炎是指眼部葡萄膜及其周围结构的炎症,具有导致视力损害的重大风险,黄斑水肿(UME)是一种常见的并发症。本声明回顾了UME的患病率、发病机制、诊断和管理策略,重点关注全身和局部皮质类固醇疗法的效用。皮质类固醇对炎症途径具有多方面的作用,是UME治疗的基石。根据炎症的解剖类型和严重程度,采用包括局部、眼周、眼内和全身等各种给药途径。通过临床试验和回顾性研究评估了不同皮质类固醇制剂的疗效,如地氟泼尼龙、曲安奈德、地塞米松植入剂和氟轻松植入剂。此外,还探讨了皮质类固醇节省疗法的作用,包括甲氨蝶呤和霉酚酸酯等抗代谢药物。新兴技术,如脉络膜上腔注射曲安奈德,为管理UME提供了有前景的替代方法。通过对现有证据的全面审查,本综述为优化UME的管理和改善葡萄膜炎患者的视力预后提供了有价值的见解。

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