地塞米松玻璃体腔植入剂治疗非动脉炎性前部缺血性视神经病变

Efficacy of Dexamethasone intravitreal implant in treating non-arteritic anterior ischemic optic neuropathy

目的:探究地塞米松玻璃体腔植入剂(DEX)治疗非动脉炎性前部缺血性视神经病变(NAION)的效果和安全性,以及不同病程的应答反应。方法:回顾性研究。纳入2018-01/2020-12在郑州大学第一附属医院诊断为NAION的患者70例70眼,根据治疗方式不同分为两组,常规治疗组35例35眼仅接受常规注射用甲泼尼龙琥珀酸钠冲击、改善微循环和营养神经治疗,联合治疗组35例35眼接受常规治疗联合DEX治疗。比较两组患者以及不同病程的患者治疗前和治疗后3mo最佳矫正视力(BCVA)、平均视野缺损(MD)、模式标准差(PSD)、视盘视网膜神经纤维层平均厚度(RNFL)和眼压。结果:两组患者治疗后3mo BCVA和MD较治疗前均改善(P<0.05),联合治疗组治疗前后PSD无差异(P>0.05),常规治疗组较治疗前恶化(P<0.05)。联合治疗组治疗后3mo BCVA和MD及PSD较常规治疗组改善(P<0.05),联合治疗组治疗后3mo总有效率较常规治疗组高(P<0.05),两组治疗后3mo RNFL平均厚度无差异(P>0.05)。在病程≤15d患者中,联合治疗组治疗后3mo BCVA和PSD及总有效率优于常规治疗组(P<0.05),在病程>15d患者中,两组BCVA和PSD及总有效率无差异(P>0.05)。联合治疗组治疗后3mo较常规治疗组出现轻度可控的眼压升高。结论:DEX治疗NAION安全有效,发病≤15d内治疗效果更佳。

AIM:To explore the therapeutic effects and safety of dexamethasone intravitreal implant(DEX)on non-arteritic anterior ischemic optic neuropathy(NAION),and responses to the different course of disease.METHODS:Totally 70 patients(70 eyes)in the First Affiliated Hospital of Zhengzhou University diagnosed with NAION from January 2018 to December 2020 were obtained retrospectively as combination treatment group and routine treatment group.35 patients(35 eyes)in each group received usual care(methylprednisolne pluse therapy,microcirculation improvement and neurotrophic treatment),and combination treatment group also received a dexamethasone intravitreal implant.The best corrected visual acuity(BCVA),mean damage(MD)and pattern standard deviation(PSD)of the visual field,mean thickness of the retinal nerve fiber layer(RNFL)and intraocular pressure(IOP)were compared between the two groups,and two groups with a different course of disease before and 3mo after treatment.RESULTS:BCVA and MD improved in both groups at 3mo after treatment(P<0.05).The PSD in the combination treatment group was not significantly different before and after treatment(P>0.05).The PSD at 3mo after treatment in the routine treatment group was worse than before treatment(P<0.05).BCVA,MD,and PSD in the combination treatment group had better improvement than in the routine treatment group at 3mo after treatment(P<0.05).Visual acuity improvement rate in the combination treatment group was higher than in the routine treatment group at 3mo after treatment(P<0.05).There was no obvious difference in RNFL thickness between the two groups(P>0.05).BCVA,PSD and effective rate in the combination treatment group had better improvement than in the routine treatment group in disease course≤15d at 3mo after treatment(P<0.05),and no apparent difference in the group of disease course>15d(P>0.05).There was a mild and controllable increase in IOP in the combination treatment group compared to routine treatment group.CONCLUSION:Dexamethasone intravitreal implant can promote BCVA and the recovery of visual function for the long term.It is deemed safe and effective in treating NAION,with better therapeutic effects within 2wk after onset.