阿达木单抗联合地塞米松玻璃体腔植入剂治疗难治性非感染性葡萄膜炎性黄斑水肿

Adalimumab combined with Dexamethasone intravitreal implant in the treatment of refractory noninfectious uveitis macular edema

目的:探讨阿达木单抗联合地塞米松玻璃体腔植入剂治疗难治性非感染性葡萄膜炎性黄斑水肿(UME)的效果。方法:选取2020-01/2022-01我院收治的难治性非感染性UME患者92例131眼,随机分为对照组(46例63眼,接受地塞米松玻璃体腔植入剂治疗)和观察组(46例68眼,接受阿达木单抗皮下注射联合地塞米松玻璃体腔植入剂治疗)。分别于治疗前后检测最佳矫正视力(BCVA)、中心凹视网膜厚度(CRT)、玻璃体炎性混浊程度以及Th17/Treg细胞因子水平,记录不良反应发生情况。结果:纳入患者失访3例4眼。治疗1、3、6、12 mo,两组患者BCVA均较治疗前改善,CRT、玻璃体炎性混浊程度评分、血清白细胞介素(IL)-17、IL-22水平均较治疗前降低,血清转化生长因子-β(TGF-β)、IL-10水平均较治疗前升高,且观察组患者BCVA优于对照组,CRT、玻璃体炎性混浊程度评分、血清IL-17、IL-22水平均低于对照组,血清TGF-β、IL-10水平均高于对照组(均P<0.05)。治疗及随访期间,两组患者均未出现严重的不良反应。结论:阿达木单抗联合地塞米松玻璃体腔植入剂治疗难治性非感染性UME可显著促使黄斑水肿消退,减轻玻璃体炎性混浊,改善视力。

AIM:To investigate the effect of adalimumab combined with dexamethasone intravitreal implant in the treatment of refractory non-infectious uveitis macular edema(UME).METHODS:A total of 92 cases(131 eyes)of refractory non-infectious UME patients admitted to our hospital from January 2020 to January 2022 were selected and randomly divided into control group,with 46 cases(63 eyes)treated with dexamethasone intravitreal implant and observation group,with 46 cases(68 eyes)treated with adalimumab subcutaneous injection combined with dexamethasone intravitreal implant.The best corrected visual acuity(BCVA),central retinal thickness(CRT),vitreous opacity and Th17/Treg cytokines were measured before and after treatment,and the occurrence of adverse reactions was recorded.RESULTS:Totally 3 cases(4 eyes)were lost to follow-up.After treatment for 1,3,6 and 12 mo,BCVA was improved in both groups compared with that before treatment,and CRT,vitreous opacity score,serum interleukin(IL)-17 and IL-22 levels were decreased compared with those before treatment,and serum transforming growth factor-β(TGF-β)and IL-10 levels were increased compared with those before treatment.BCVA in the observation group was better than that in the control group,and CRT,vitreous opacity score,serum IL-17 and IL-22 levels were lower than those in the control group,and serum TGF-βand IL-10 levels were higher than those in the control group(all P<0.05).During treatment and follow-up,no serious adverse reactions occurred in both groups.CONCLUSION:Adalimumab combined with dexamethasone intravitreal implants in the treatment of refractory non-infectious UME can significantly subside the macular edema,reduce vitreous opacity and improve visual acuity.