局部注射曲安奈德用于治疗黄斑水肿有效性和安全性的系统评价  

Efficacy and safety of local ocular injection of triamcinolone acetonide for patients with macular edema: a systematic review

作　　者：徐姗姗[1] 宋智慧[1] 李光耀 张弨 XU Shan-shan;SONG Zhi-hui;LI Guan-yao;ZHANG Chao(Department of Pharrnacy,Beijing Tongren Hospital,Capital Medicine University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院药学部,北京100730

出　　处：《临床药物治疗杂志》2022年第10期23-29,共7页Clinical Medication Journal

摘　　要：目的 系统评价局部注射曲安奈德(TA)用于治疗黄斑水肿(ME)的有效性和安全性。方法 检索CNKI、Wanfang data、Pubmed、Embase和Cochrane Library数据库,搜集眼局部注射曲安奈德用于治疗黄斑水肿的随机对照试验,采用RevMan 5.4软件进行Meta分析。结果 共纳入17个RCT。meta分析结果显示,在最佳矫正视力(BCVA)的提升方面,6个月内曲安奈德优于激光光凝术,12个月时二者差异无统计学意义;与抗血管内皮生长因子(anti-VEGF)和地塞米松玻璃体内植入剂(DII)相比,曲安奈德在12个月内差异均无统计学意义。在黄斑中心视网膜厚度(CMT)的减轻方面,6个月时anti-VEGF的效果优于曲安奈德,而12个月时曲安奈德的效果更好;与激光光凝术相比,曲安奈德在6个月内能有效减轻患者的黄斑水肿,12个月时二者差异无统计学意义;与DII相比,差异相比6个月内差异无统计学意义。在安全性方面,仅和激光光凝术相比曲安奈德在12个月时眼内压的升高程度更大,其余差异均无统计学意义;曲安奈德在高眼压症的发生率方面均高于anti-VEGF和激光光凝术,但与DII相比,差异无统计学意义;曲安奈德在白内障进展的发生率方面与其余治疗组无统计学差异。结论 局部注射曲安奈德可有效提升黄斑水肿患者的BCVA并减少CMT,但是有升高眼压的风险,临床应用时应评估获益和风险后选择合适的治疗方案。Objectives To systematically review the efficacy and safety of local ocular injection of triamcinolone acetonide for patients with macular edema. Methods CNKI,WanFang Data,PubMed,EMbase and Cochrane Library databases were electronically searched to collect randomized controlled trials(RCTs)on local ocular injection of triamcinolone acetonide for patients with macular edema. The meta-analysis was performed by using RevMan 5. 4 software. Results A total of 17RCTs were included. The results of meta-analysis revealed that TA showed more improvement in best corrected visual acuity(BCVA)compared to grid laser within 6 months,but with no statistical differences at 12 months. There were no statistical differences between TA and anti-vascular endothelial growth factor(Anti-VEGF)or dexamethasone intravitreal implant(DII)within 12 months. Anti-VEGF showed more effective than TA at reducing central macular thickness(CMT)at 6 months,but TA showed more effectiveness at 12 months. TA showed more effective than grid laser at reducing CMT at 6 months,but with no statistical differences at 12 months. There were no statistical differences between TA and DII at 6 months. TA only showed more elevation on intraocular pressure(IOP)compared to grid laser at 12 months and showed no statistical differences with other treatments. TA showed more risk of intraocular hypertension(IOH)than Anti-VEGF and grid laser,but showed no statistical differences with DII. TA showed no statistical differences on the progression of cataract with other treatments. Conclusions Local ocular injection of TA can effectively improve BCVA and reduce CMT for patients with macular edema,but with the risk of IOH. In clinical application,appropriate treatment should be selected after evaluating the benefits and risks.

关 键 词：黄斑水肿 曲安奈德 META分析 系统评价 随机对照试验 

分 类 号：R988.1[医药卫生—药品] R774.5[医药卫生—药学]