地塞米松玻璃体内植入剂在非感染性葡萄膜炎继发黄斑水肿患者治疗中的作用

Role of dexamethasone intravitreal implants in the treatment of macular edema secondary to non-infectious uveitis

目的观察地塞米松玻璃体内植入剂在治疗非感染性葡萄膜炎继发黄斑水肿中的安全性和临床疗效。方法回顾性分析我院2019年12月至2021年12月临床确诊的非感染性葡萄膜炎继发黄斑水肿患者30例(30眼),给予玻璃体内注射地塞米松玻璃体内植入剂治疗。所有患眼均行最佳矫正视力(BCVA)及眼压测量,并采用OCT测量黄斑中心视网膜厚度(CMT)。术后随访6个月,所有患者均于术前,术后1个月、3个月及6个月重复检测并比较BCVA、CMT。随访期间观察患者眼压变化,监测白内障进展、结膜下出血等眼部不良反应。结果患者术前及术后1个月、3个月及6个月BCVA(logMAR)分别为0.74±0.37、0.47±0.29、0.28±0.14、0.37±0.17。患者术前,术后1个月、3个月及6个月CMT分别为(372.12±99.42)μm、(298.14±82.44)μm、(278.45±62.43)μm、(289.31±56.34)μm。患者各时间点BCVA、CMT差异均有统计学意义(均为P<0.05)。与术前相比,患者术后1个月、3个月及6个月BCVA和CMT差异均有统计学意义(均为P<0.05)。术后各时间点两两比较结果显示,患者BCVA和CMT差异均无统计学意义(均为P>0.05)。随访期间有6例患者出现眼压升高(≥25 mmHg,1 kPa=7.5 mmHg),经局部降眼压药物应用后降至正常水平。4例患者出现白内障进展,均无需手术治疗。结论玻璃体内注射地塞米松玻璃体内植入剂能够提高患者视力及降低CMT,有效治疗非感染性葡萄膜炎继发黄斑水肿。

Objective To investigate the safety and clinical efficacy of dexamethasone intravitreal implant in the treatment of macular edema secondary to non-infectious uveitis.Methods In this retrospective study,30 patients(30 eyes)with clinically confirmed macular edema secondary to non-infectious uveitis in our hospital from December 2019 to December 2021 were treated with intravitreal injection of dexamethasone implants.The best corrected visual acuity(BCVA)and intraocular pressure(IOP)of all affected eyes were measured.The central macular thickness(CMT)was evaluated by optical coherence tomography.During the follow-up 6 months,all patients received repeated measurements of BCVA and CMT at 1,3 and 6 months after surgery.In addition,IOP changes,cataract progression,and subconjunctival hemorrhage were monitored.Results The BCVA(logMAR)before and 1,3 and 6 months after surgery was 0.74±0.37,0.47±0.29,0.28±0.14,and 0.37±0.17,respectively.The CMT before and 1,3 and 6 months after surgery was(372.12±99.42)μm,(298.14±82.44)μm,(278.45±62.43)μm,and(289.31±56.34)μm,respectively.Significant differences were found in BCVA and CMT at different time points(P<0.05).Compared with the preoperative conditions,the BCVA and CMT of all eyes significantly changed at 1,3 and 6 months after surgery(all P<0.05).There was no significant difference in the pairwise comparisons of BCVA and CMT at various time points after surgery(all P>0.05).During the follow-up periods,IOP elevated(≥25 mmHg,1 kPa=7.5 mmHg)in 6 patients,but decreased to the normal level after local IOP-lowering medication.Cataract progression occurred in 4 patients,none of which required surgery.Conclusion Dexamethasone intravitreal implants can improve visual acuity and reduce CMT;thus,it is an effective approach to treat macular edema secondary to non-infectious uveitis.