玻璃体内地塞米松植入剂治疗难治性糖尿病性黄斑水肿的效果观察  

Observation on the efficacy of intravitreal dexamethasone implantation in the treatment of refractory macular edema in diabetes

作　　者：何浩然 周明[1] 刘豪杰[1] 胥利平[1] 吴琪 严鑫 He Haoran;Zhou Ming;Liu Haojie;Xu Liping;Wu Qi;Yan Xin(Department of Ophthalmology,Affiliated Zhongshan Hospital Dalian University,Dalian 116001,China)

机构地区：[1]大连大学附属中山医院眼科,大连116001

出　　处：《中华眼外伤职业眼病杂志》2023年第3期161-167,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察玻璃体腔内注射地塞米松植入剂傲迪适(Ozurdex)治疗难治性糖尿病性黄斑性水肿(DME)的临床效果。方法采用回顾性病例对照研究。收集大连大学附属中山医院2021年7月至2022年3月难治性DME 60例(62只眼),按治疗方式不同分为玻璃体内注射地塞米松植入剂的30例(31只眼,观察组)及玻璃体内注射抗血管内皮生长因子(VEGF)药物的30例(31只眼,对照组)。随访观察6个月,观察治疗前后视力(BCVA,logMAR)、黄斑中心区厚度(CSMT)及眼压等。结果两组治疗前后各时间点BCVA差异均有统计学意义(F=34.40,P<0.001),两组治疗后各时间点BCVA较治疗前均提高(均P<0.05)。两组治疗前后各时间点CSMT差异均有统计学意义(F=22.72,P<0.001);观察组治疗后1个月CSMT(458.19±168.18)μm、2个月(289.13±81.32)μm、3个月(327.13±77.55)μm、4个月(374.19±62.83)μm、及6个月(419.45±77.00)μm与治疗前为(633.06±217.25)μm相比,均显著下降(均P<0.05)。对照组仅治疗后1个月CSMT[(584.23±185.56)μm]与治疗前(619.58±217.25)μm相比,差异有统计学意义(P<0.05)。两组治疗前后各时间点眼压差异有统计学意义(F=15.73,P<0.001)。观察组治疗后1个月眼压为(16.55±1.52)mmHg、2个月为(18.55±2.01)mmHg、3个月为(16.74±1.61)mmHg均高于治疗前的(14.29±1.75)mmHg(1mmHg=0.133kPa,均P<0.05);治疗后6个月眼压为(14.23±1.23)mmHg与治疗前相比差异无统计学意义(t=0.33,P=0.748)。对照组治疗后各时间点眼压与治疗前相比无明显改变(均P>0.05)。结论玻璃体内注射地塞米松植入剂傲迪适治疗难治性DME可有效提高视力、减轻黄斑水肿程度。Objective To observe the clinical efficacy of intravitreal dexamethasone implantation Ozurdex in the treatment of refractory diabetic macular edema.Methods This was a retrospective case-control study.A total of 62 eyes of 60 patients with refractory DME in Affiliated Zhongshan Hospital Dalian University collected from Jul.2021 to Mar.2022 were divided into two groups.Thirty-one eyes of 30 cases in the observation group received intravitreal injection of dexamethasone implants and 31 eyes of 30 cases in the control group received intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs.The patients were followed up for 6 months to observe the visual acuity,the thickness of central subfield macular area,and intraocular pressure before and after treatment.Results There were statistically significant differences in the visual acuity(BCVA)between the two groups at each time point before and after treatment(F=34.40,P<0.001).The BCVA at each time point after treatment in the two groups was higher than that before treatment(all P<0.05).There were statistically significant differences in the central subfield macular thickness(CSMT)between the two groups at each time point before and after treatment(F=22.72,P<0.001).The CSMT of the observation group at 1 month after treatment[(458.19±168.18)μm],2 months[(289.13±81.32)μm],3 months[(327.13±77.55)μm],4 months[(374.19±62.83)μm],and 6 months[(419.45±77.00)μm]were significantly lower than that before treatment[(633.06±217.25)μm](all P<0.05).In the control group,there was a statistically significant difference in CSMT at only 1 month after treatment[(584.23±185.56)μm]compared with that before treatment[(619.58±217.25)μm](P<0.05).The difference of intraocular pressure between the two groups at each time point before and after treatment was statistically significant(F=15.73,all P<0.001).The intraocular pressure of the observation group at 1 month after treatment[(16.55±1.52)mmHg],2 months[(18.55±2.01)mmHg],3 months[(16.74±1.61)mmHg]was signifi

关 键 词：黄斑水肿 糖尿病视膜膜病变 药物植入物 地塞米松 视力 眼压 

分 类 号：R587.2[医药卫生—内分泌] R774.5[医药卫生—内科学]