抗VEGF联合地塞米松玻璃体内植入剂治疗难治性糖尿病性黄斑水肿的效果  

The efficacy of intravitreal anti-VEGF injection and intravitreal dexamethasone implant in the treatment of refractory diabetic macular edema

作　　者：梁雪梅[1] 沈白云 欧足国 李莉[1] Liang Xuemei;Shen Baiyun;Ou Zuguo;Li Li(Nanning Aier Eye Hospital,Nanning 530012,China)

机构地区：[1]南宁爱尔眼科医院,南宁530012

出　　处：《中华眼外伤职业眼病杂志》2023年第7期517-525,共9页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：广西自治区卫健委西医类别自筹经费科研课题(Z-A20231293)。

摘　　要：目的评估玻璃体内注射抗VEGF药物联合地塞米松玻璃体内植入剂傲迪适治疗难治性糖尿病性黄斑水肿(DME)的效果。方法回顾性病例对照研究。分析南宁爱尔眼科医院2020年1月至2022年1月的难治性DME 42例(74眼)的临床资料。所有患眼既往至少接受过3次每月1次的雷珠单抗注射治疗。按治疗方式分为两组:单药组25例(43眼),康柏西普注射(1+按需治疗PRN)治疗;联合组17例(31眼),康柏西普联合傲迪适注射。随访12个月,观察各组换药前后的最佳矫正视力(BCVA,logMAR)及黄斑中心区厚度(CMT)。结果组内比较:单药组换药后3个月及12个月的CMT较换药前明显下降(P=0.023、0.034),但视力无明显提高(P=0.442、0.665)。联合组换药后3个月视力和CMT较换药前均明显改善(P=0.023、P<0.001),但12个月时视力及CMT均较换药后3个月变差(P=0.032、0.034)。组间比较:联合组3个月时视力及CMT较单药组显著改善(P=0.035、0.013)。基线到换药后3个月视力提高量单药组0.29±0.18,联合组0.40±0.17,两组差异有统计学意义(P=0.032)。从基线到换药后3个月CMT下降量单药组(189.20±121.86)μm,联合组(250.70±100.01)μm,两组差异有统计学意义(P=0.017)。结论玻璃体内注射抗VEGF联合傲迪适治疗难治性DME早期可改善黄斑水肿,显著提高视力。Objective To evaluate the efficacy of intravitreal antivascular endothelial growth factor(anti-VEGF)injection and intravitreal dexamethasone implant(IDI)for refractory diabetic macular edema(DME).Methods This was a retrospective case control study.Clinical data of 74 eyes of 42 patients with refractory DME from Jan.2020 to Jan.2022 in Nanning Aier Eye Hospital were analyzed.All of them had previously received at least 3 monthly intravitreal ranibizumab injections.The patients were divided into two groups based on the treatment method.Monotherapy group with 43 eyes of 25 cases switched to conbercept injection(1+PRN).Combination group with 31 eyes of 17 cases received IDI combined with intravitreal conbercept injections.The follow-up period was 12 months.The best corrected visual acuity(BCVA,logMAR)and central macular thickness(CMT)before and after switching drug were observed.Results In monotherapy group,CMT was significantly decreased after switching drug(P=0.023,0.034),however,the BCVA had no significant improvement at either 3 or 12 months after switching drug(P=0.442,0.665).In combination group,BCVA was significantly improved and CMT decreased at 3 months after switching drug(P=0.023,P<0.001).However,BCVA and CMT at 12 months worsen again compared with 3 months(P=0.032,0.034).Compared between groups,BCVA improvement and CMT decreased in the combination group,those were significantly better compared with those in the monotherapy group at only 3 months after switching drug(P=0.035,0.013).Mean changes of BCVA from baseline to 3 months after switching drug was 0.29±0.18 in monotherapy group and 0.40±0.17 in the combination group(P=0.032).Moreover,the mean reductions in CMT were(189.20±121.86)μm in monotherapy group versus(250.70±100.01)μm in the combination group,the difference was statistically significant(P=0.017).Conclusion IDI combined with intravitreal anti-VEGF injection in patients with refractory DME can significantly improve the visual acuity and reduce macular edema at early stage.

关 键 词：水肿 黄斑 糖尿病性 难治性 治疗 联合 抗VEGF 傲迪适 视力 黄斑中心区厚度 

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