地塞米松玻璃体腔植入剂治疗活动性非感染性葡萄膜炎黄斑水肿的疗效观察  

Clinical efficacy of dexamethasone intravitreal Implant in the treatment of active non-infectious uveitis with macular edema

作　　者：叶娅 宋艳萍 Ye Ya;Song Yanping(Department of Ophthalmology,Central Theater Command General Hospital,Wuhan 430070,China)

机构地区：[1]中国人民解放军中部战区总医院眼科,武汉430070

出　　处：《中华眼底病杂志》2020年第9期691-696,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察地塞米松玻璃体腔植入剂(DEX)治疗活动性非感染性葡萄膜炎黄斑水肿(NIU-ME)的临床疗效。方法回顾性观察研究。2018年2月至2019年2月在中部战区总医院眼科确诊为NIU-ME并接受玻璃体腔注射DEX治疗的23例患者26只眼纳入研究。其中,男性8例8只眼,女性15例18只眼;平均年龄46.9岁;平均病程(9.2±2.4)个月。所有患眼均行BCVA、眼压检查;同时采用OCT测量黄斑中心视网膜厚度(CMT)。视力检查采用Snellen视力表进行。患眼平均BCVA为0.281±0.191,平均眼压为(16.2±0.8)mmHg(1 mmHg=0.133 kPa),平均CMT为(395.4±63.7)μm。23例患者中,中间葡萄膜炎8例,后部葡萄膜炎15例。曾接受静脉滴注甲强龙治疗7例,甲强龙联合免疫抑制剂治疗5例,未接受任何治疗11例。所有患眼均接受玻璃体腔注射DEX治疗。注射后随访,重复行视力、眼压及OCT检查。随访期间对于水肿复发或疗效不佳者,根据患者自身条件考虑全身使用甲泼尼龙和玻璃体腔再次注射DEX、曲安奈德或甲氨蝶呤治疗。观察患眼注射前后BCVA、眼压以及CMT的变化,并行单个重复测量因素的方差分析。同时观察眼部不良反应及全身并发症的发生情况。结果治疗后(1.2±0.4)、(3.3±0.3)、(6.7±1.1)、(9.2±1.1)、(12.2±0.6)个月,患眼BCVA分别为0.488±0.296、0.484±0.266、0.414±0.247、0.411±0.244、0.383±0.232;CMT分别为(280.2±42.7)、(271.0±41.4)、(292.5±42.9)、(276.2±40.5)、(268.4±26.6)μm。与治疗前比较,患眼治疗后BCVA提高,CMT明显降低,差异均有统计学意义(F=30.99、5196.92,P<0.000)。治疗后(12.2±0.6)个月,完成整个随访的23只眼中,13只眼(56.5%)进行了2次注射,3只眼(13.0%)进行了3次注射,其余7只眼(30.4%)只进行了1次注射。治疗后(1.2±0.4)个月,眼压>25 mmHg者5例6只眼,经两种降眼压滴眼液治疗后逐渐恢复正常;眼压>40 mmHg者1例2只眼,经3种降眼压滴眼液治疗后眼压逐渐恢复正常。结论玻璃体�Objective To observe the clinical efficacy of dexamethasone intravitreal implant(DEX)in the treatment of active non-infectious uveitis macular edema(NIU-ME).Methods A retrospective observational study.From February 2018 to February 2019,23 patients(26 eyes)were included in the study who were diagnosed with NIU-ME at the Department of Ophthalmology,Central Theater Command General Hospital and received intravitreal DEX treatment.Among 23 patients,there were 8 males(8 eyes)and 15 females(18 eyes);the average age was 46.9 years;the average course of disease was 9.2±2.4 months.All the affected eyes underwent BCVA and intraocular pressure examination;at the same time,OCT was used to measure the central retinal thickness(CMT)of the macula.Snellen visual acuity chart was used for visual inspection.The average BCVA of the affected eye was 0.281±0.191,the average intraocular pressure was 16.2±0.8 mmHg(1 mmHg=0.133 kPa),and the average CMT was 395.4±63.7μm.Among the 23 patients,8 patients had middle uveitis and 15 patients had posterior uveitis.Seven patients had received intravenous infusion of methylprednisolone,5 patients had been treated with methylprednisolone combined with immunosuppressive agents,and 11 patients had not received any treatment.All the affected eyes were treated with DEX intravitreal injection.Patients received repeated visual acuity,intraocular pressure and OCT examination with follow-up after injection.During the follow-up period,patients with recurrence of edema or poor efficacy,systemic methylprednisolone and intravitreal reinjection of DEX,triamcinolone acetonide or methotrexate should be considered based on the patient's own conditions.We observed the changes of BCVA,intraocular pressure and CMT before and after injection in the affected eyes,and analyzed the variance of a single repeated measurement factor.At the same time,we observed the occurrence of ocular adverse reactions and systemic complications.Results After treatment 1.2±0.4,3.3±0.3,6.7±1.1,9.2±1.1,12.2±0.6 months,the BCVA of

关 键 词：葡萄膜炎/并发症 黄斑水肿 地塞米松 迟效制剂 玻璃体内注射 

分 类 号：R774.5[医药卫生—眼科]