Meduri Alessandro, De Luca Laura, Oliverio Giovanni William, Mancini Maura, Minutoli Letteria, Silvagno Francesca, Bergandi Loredana, Aragona Pasquale
Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, Messina, Italy.
Department of Clinical and Experimental Medicine and Pharmacology, Section of Pharmacology, University of Messina, Messina, Italy; and.
Retina. 2025 Jun 1;45(6):1030-1042. doi: 10.1097/IAE.0000000000004381.
This literature review synthetizes current evidence on the timing and efficacy of dexamethasone intravitreal injections for diabetic macular edema in patients undergoing cataract surgery, particularly phacoemulsification, to determine the optimal timing for improved outcome.
A systematic review of the literature was conducted across key databases to identify peer-reviewed studies, clinical trials, and meta-analyses addressing dexamethasone injections administered pre-, intra-, and postoperatively for diabetic macular edema in the context of cataract surgery. Studies were selected based on relevance to timing, visual outcomes, and inflammation control, with a focus on comparative efficacy.
The findings suggest that timely dexamethasone injections can substantially reduce inflammation and enhance visual recovery for patients with diabetic macular edema undergoing cataract surgery. Studies indicate that preoperative injections may effectively dampen the inflammatory response triggered by surgical trauma, potentially preserving retinal integrity, whereas intraoperative and postoperative administrations contribute to sustained anti-inflammatory effects during the recovery phase. Comparative studies also highlight dexamethasone's advantages over other anti-inflammatory treatments, such as NSAIDs, particularly in preventing cystoid macular edema. Notably, there was considerable variation in dosage and timing across studies, underscoring the need for standardized treatment protocols.
Dexamethasone intravitreal injections offer a valuable intervention for managing diabetic macular edema in diabetic patients undergoing cataract surgery, with optimal timing playing a crucial role in maximizing therapeutic benefits. Preoperative injections appear to be particularly beneficial in reducing the risk of postoperative inflammatory complications. Further research should focus on developing comprehensive guidelines for timing and dosage to standardize treatment and improve patient outcomes in this high-risk population.
本综述综合了目前关于在接受白内障手术（尤其是超声乳化手术）的糖尿病性黄斑水肿患者中玻璃体内注射地塞米松的时机和疗效的证据，以确定改善预后的最佳时机。
对主要数据库进行系统的文献综述，以识别针对白内障手术中糖尿病性黄斑水肿术前、术中和术后给予地塞米松注射的同行评审研究、临床试验和荟萃分析。根据与时机、视觉结果和炎症控制的相关性选择研究，重点是比较疗效。
研究结果表明，及时注射地塞米松可显著减轻接受白内障手术的糖尿病性黄斑水肿患者的炎症并促进视力恢复。研究表明，术前注射可能有效抑制手术创伤引发的炎症反应，有可能保护视网膜完整性，而术中和术后给药有助于在恢复阶段维持抗炎作用。比较研究还突出了地塞米松相对于其他抗炎治疗（如非甾体抗炎药）的优势，特别是在预防黄斑囊样水肿方面。值得注意的是，各研究在剂量和时机方面存在很大差异，这凸显了标准化治疗方案的必要性。
玻璃体内注射地塞米松为接受白内障手术的糖尿病患者管理糖尿病性黄斑水肿提供了一种有价值的干预措施，最佳时机对最大化治疗益处起着关键作用。术前注射在降低术后炎症并发症风险方面似乎特别有益。进一步的研究应侧重于制定关于时机和剂量的综合指南，以规范治疗并改善这一高危人群的患者预后。
