摘要
目的评估地塞米松玻璃体腔植入剂Ozurdex治疗难治性视网膜静脉阻塞(RVO)继发黄斑水肿的有效性及安全性。方法采用系列病例观察研究,纳入2016年3月至2019年9月在北京爱尔英智眼科医院确诊为难治性RVO继发黄斑水肿并采用玻璃体腔注射Ozurdex治疗的患者21例21眼,所有患者病程≥3个月,至少经过2次抗VEGF药物治疗后黄斑水肿仍反复发作,视力无明显提高或进一步下降。所有患眼均行玻璃体腔注射Ozurdex,均于注射前,注射后1、2、3、6个月行最佳矫正视力(BCVA)和眼压测量,同时采用光相干断层扫描(OCT)测量黄斑中心凹视网膜厚度(CRT)。随诊期间,对于黄斑水肿复发或疗效不佳者,根据患者自身情况考虑玻璃体腔再次注射Ozurdex或雷珠单抗治疗,同时观察眼部不良反应及全身并发症情况。结果Ozurdex注射后共随访6个月,注射后1、2、3、6个月平均CRT分别为(295.76±49.19)、(280.33±39.44)、(321.29±73.46)和(300.29±75.10)μm,均明显低于注射前的(458.52±174.61)μm,差异均有统计学意义(均P<0.05)。注射前后各时间点BCVA总体比较差异无统计学意义(F=1.975,P>0.05)。6个月随访期间共10眼黄斑水肿复发,复发时间为首次注射后2~6个月,平均(4.1±1.5)个月,其中8眼再次注射Ozurdex治疗后末次随访CRT较复发时下降,BCVA较复发时提高,差异均有统计学意义(t=5.254,P=0.001;t=4.277,P=0.004)。随访期间眼压升高为最常见的不良反应,Ozurdex注射后2个月患者眼压明显高于注射前基线值,差异有统计学意义(P=0.01),随访期间3眼眼压≥25 mmHg,占14.3%,通过局部应用降眼压药物均得到控制。所有患者均未出现玻璃体积血、视网膜脱离、眼内炎等严重不良反应或全身并发症。结论对于难治性RVO继发黄斑水肿患者,单次Ozurdex注射可带来长达4~6个月的显著解剖学改善并维持患者基线视力,对于复发患者,再次注射Ozurdex依然有效,其短期不良反
Objective To evaluate the efficacy and safety of dexamethasone intravitreal implant(Ozurdex)in treating the refractory macular edema caused by retinal vein occlusion(RVO).Methods An observational case series study was conducted.Twenty-one eyes of 21 patients diagnosed as refractory macular edema secondary to RVO and treated with Ozurdex implant in Beijing Aier-Intech Eye Hospital from March 2016 to September 2019,who was with a course lasting longer than 3 months and received at least 2 times of anti-VEGF treatments,had recurrent macular edema and no visual improvement or even deteriorated,were included.Best corrected visual acuity(BCVA)was examined using standard visual chart and was converted to logarithm of the minimal angle of resolution(LogMAR)units and intraocular pressure(IOP)was examined.Optical coherence tomography(OCT)was used to measure central retinal thickness(CRT)in all eyes before and at 1,2,3 and 6 months after intravitreal injection of Ozurdex.The changes of BCVA,IOP and CRT before and after Ozurdex injection were observed and analyzed.During the 6-month follow-up,re-injection of Ozurdex or ranibizumab was adopted among those with macular edema recurrence or poor efficacy according to the subjects'conditions.Ocular adverse effects and potential systemic complications were observed.This study followed the Declaration of Helsinki and the study protocol was approved by an Ecthics Committee of Beijing Aier-Intech Eye Hospital(No.BJAIER2020IRB01).Results The mean CRT at 1,2,3,6 months after Ozurdex injection was(295.76±49.19),(280.33±39.44),(321.29±73.46),(300.29±75.10)μm,respectively,which were significantly decreased in comparison with(458.52±174.61)μm at baseline(all at P<0.05).There was no significant difference in mean BCVA at different time points before and after Ozurdex injection(F=1.975,P>0.05).During the follow-up,10 eyes had macular edema recurrence at 2 to 6 months after first Ozurdex injection,with an average of(4.1±1.5)months.Among them,8 eyes received second Ozurdex injection,an
作者
李静
谷威
Li Jing;Gu Wei(Beijing Aier-Intech Eye Hospital,Beijing 100021,China)
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2021年第5期444-449,共6页
Chinese Journal Of Experimental Ophthalmology
关键词
视网膜静脉阻塞
黄斑水肿
地塞米松
血管内皮生长因子
难治性
Retinal vein occlusion
Macular edema
Dexamethasone
Vascular endothelial growth factor
Refractory
