玻璃体腔内注射地塞米松缓释剂治疗不同类型糖尿病黄斑水肿的疗效观察

Efficacy of dexamethasone sustained-release agent for different types of diabetic macular edema

目的观察玻璃体腔内注射地塞米松缓释剂治疗不同类型糖尿病黄斑水肿(DME)的疗效和安全性。方法选取2018年7月至2020年10月在宁波市眼科医院就诊的DME并初次接受玻璃体腔注射地塞米松缓释剂治疗的患者41例41眼。根据光学相干断层扫描分型,将患者分为海绵样水肿(DRT)型(DRT组)10例10眼、黄斑囊样水肿(CME)型(CME组)22例22眼、浆液性神经上皮脱离(SRD)型(SRD组)9例9眼。比较3组患者治疗前、治疗后1、2、3、6个月最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)的差异,并记录患者不良反应发生情况。结果与治疗前比较,3组患者治疗后1、2个月BCVA和CMT均下降,SRD组患者治疗后第3个月CMT下降,差异均有统计学意义(均P<0.05)。3组患者治疗前后BCVA比较差异均无统计学意义(均P>0.05);3组患者治疗前、治疗后1、2、6个月CMT比较差异均无统计学意义(均P>0.05),但3组患者治疗后第3个月CMT比较差异有统计学意义(P<0.05)。4例患者在治疗后眼压升高,8例患者结膜出血,1例患者玻璃体出血,2例有晶状体眼出现白内障轻度进展。结论玻璃体腔内注射地塞米松缓释剂治疗不同类型DME均安全有效,其中SRD型的疗效维持时间更长。

Objective To evaluate the efficacy and safety of intravitreal dexamethasone in patients with different types of diabetes macular edema(DME).Methods Forty-one patients(41 eyes)with DME admitted in Ningbo Eye Hospital from July 2018 to October 2020 who received intravitreal injection of dexamethasone sustained release agent for the first time were enrolled.According to the classification of optical coherence tomography,there were 10 cases(10 eyes)of diffuse retinal thickening(DRT group),22 cases(22 eyes)of cystoid macular edema(CME group)and 9 cases(9 eyes)of serous retinal detachment(SRD group).The best corrected visual acuity(BCVA)and central macular thickness(CMT)of the three groups were compared before and 1,2,3 and 6 months after treatment,and the adverse reactions were recorded.Results Compared with those before treatment,BCVA and CMT decreased in the three groups at 1 and 2 months after treatment,and CMT decreased in the SRD group at 3 months after treatment(all P<0.05).There was no significant difference in BCVA among the three groups before and after treatment(all P>0.05).There was no significant difference in CMT among the three groups before and 1,2 and 6 months after treatment(all P>0.05),but there was significant difference in CMT among the three groups at 3 months after treatment(P<0.05).After treatment,there were increased intraocular pressure in 4 cases,conjunctival hemorrhage in 8 cases,vitreous hemorrhage in 1 case and slight cataract progression in 2 eyes.Conclusion Intravitreal injection of dexamethasone sustained-release agent is safe and effective in the treatment of different types of DME,and for SRD type the efficacy is longer.