Ozurdex治疗玻璃体切割术后难治性DME临床特征观察

Clinical study of Ozurdex in the treatment of refractory DME after vitrectomy

目的观察玻璃体腔注射Ozurdex治疗玻璃体切割术后难治性糖尿病性黄斑水肿(DME)的短期疗效。方法收集2020年6月~2021年1月在我院眼科就诊,先前接受过玻璃体切割手术,且经过3次以上抗新生血管药物治疗的顽固性DME患者9例(10眼),转换为玻璃体腔注射Ozurdex,进行回顾性分析。比较治疗前后最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)的变化规律及患者主要并发症情况。结果所有患者均随访12个月,BCVA较治疗前均有明显提高,从术前(0.72±0.32)logMAR提高到(0.43±0.22)logMAR,其中BCVA增加最好的时间为注射后1个月,之后BCVA缓慢提高,各时间段与治疗前比较,差异均有统计学意义(P<0.05);CMT明显下降,从术前(440.60±114.93)μm降低到(246.00±56.53)μm,患者注射Ozurdex后CMT明显下降,但注射后1周仍有轻度水肿,较抗新生血管治疗前减轻,1个月时到达较好状态,持续到3个月,之后CMT缓慢减低,与治疗前相比,差异均有统计学意义(P<0.05)。无明显全身及眼部并发症。结论对于行玻璃体切割手术且反复多次注射抗新生血管药物的顽固性DME患者,转为Ozurdex治疗能在短期内减轻黄斑区水肿程度,提高视力且无并发症的发生。

Objective To observe the short-term effect of vitreous injection of Ozurdex in the treatment of refractory DME after vitrectomy.Methods A total of 9 patients with 10 eyes of refractory DME who had previously undergone vitrectomy and had been treated with more than three times of antineovascularization therapy were selected for treatment in our hospital from June 2020 to June 2021,and converted to vitreous cavity injection of Ozurdex and retrospectively analysis were performed.The changes of best corrected visual acuity(BCVA),central macular fovea retinal thickness(CMT)and major complications were compared before and after treatment.Results The patients were followed up for 12 months,and BCVA was significantly improved compared with before treatment.It was increased from preoperative(0.72±0.32)logMAR to(0.43±0.22)logMAR.The best time for BCVA increase was 1 month after injection,after which BCVA improved slowly.The differences were statistically significant at all time periods compared with pre-treatment.CMT decreased significantly,from(440.60±114.93)μm before operation to(246.00±56.53)μm.There was still mild edema 1 w after injection,which was reduced compared to before the anti neovascularization treatment.Reached a good state at 1 m after injection and lasted until 3 months,and then CMT slowly decreased.The differences were statistically significant compared with those before treatment.There were no adverse reactions occurred.Conclusion In patients with refractory DME who have undergone vitrectomy with repeated multiple injections of anti-neovascular drugs,switching to Ozurdex treatment reduces the degree of macular edema in the short term and improves visual acuity without complications.