关键词: Consensus Corticosteroid Dexamethasone Diabetic macular edema Fluocinolone acetonide Glaucoma Implant Intraocular pressure Intravitreal Triamcinolone acetonide

来  源:   DOI:10.1007/s40123-021-00427-1   PDF(Pubmed)

Abstract:
Intravitreal therapy for diabetic macular edema can, in susceptible patients, increase intraocular pressure (IOP). As uncontrolled IOP can potentially be sight threatening, monitoring is an essential component of patient management. It can be challenging for retina specialists to ensure that monitoring is rigorous enough to detect and resolve any potential problems at the earliest opportunity without it also being overburdensome for patients who have the lowest risk of developing an IOP rise. We have developed dynamic algorithms that: (1) tailor the frequency and extent of monitoring according to individual susceptibility and current IOP and (2) assist retina specialists in deciding when they should consider a referral to a glaucoma specialist. One algorithm is for patients with a relatively low susceptibility to developing an IOP rise (those whose baseline IOP is < 22 mmHg and who do not have a history of IOP events). Depending on their first post-implantation IOP check, the algorithm classifies them as: low risk if IOP remains < 22 mmHg; medium risk if IOP is 22-25 mmHg and any rise from baseline is < 10 mmHg; or high risk if IOP is > 25 mmHg or any rise from baseline is ≥ 10 mmHg. Thereafter, the algorithm guides on the frequency and extent of monitoring required in each of these groups and, if IOP rises or falls during treatment, patients may move up or down the risk groups accordingly. A different algorithm is provided for patients who are more susceptible to developing an IOP rise (those with a baseline IOP of ≥ 22 mmHg or a prior history of an IOP event). These patients need monitoring more closely so this algorithm has only medium- or high-risk classifications. These algorithms update the previous monitoring guidance by Goñi et al. (Goñi et al. in Ophthalmol Ther 5:47-61, 2016).
Some people with diabetes have macular edema, which is a swelling of the central part of the retina (the tissue that lines the back of the eye). This swelling can threaten eyesight if untreated.Injecting a drug such as a corticosteroid into the eye can help treat the condition. Sometimes this has a side effect of increasing intraocular pressure (pressure within the eye). A small or short-lived rise in eye pressure should be no cause for concern, but it is very important to ensure the pressure is not too high for too long—because this could lead to the loss of eyesight. To prevent this happening, an eye doctor needs to check the eye pressure regularly.Some people are more susceptible to this problem—for example, people who have had any problems related to eye pressure in the past or people whose eyes already have a higher than normal pressure even before treatment. People who are most susceptible may need more types of checks and more frequent checks to ensure that any problems are found and treated quickly.We have developed flowcharts that help eye doctors decide which checks are needed and how often based on what the doctor knows about the person’s eye before treatment and what they see at each check-up after treatment. They help doctors make sure that everyone has check-ups at the right time and they help doctors spot any problems early so that they can be resolved before long-lasting damage can occur.
摘要:
玻璃体内治疗糖尿病性黄斑水肿,在易感患者中,增加眼内压(IOP)。由于不受控制的IOP可能会威胁视力,监测是患者管理的重要组成部分。对于视网膜专家来说,确保监测足够严格,以便尽早发现和解决任何潜在问题,而对于IOP升高风险最低的患者来说,这可能是一项挑战。我们开发了动态算法:(1)根据个体易感性和当前眼压调整监测的频率和程度;(2)协助视网膜专家决定何时应考虑转诊给青光眼专家。一种算法是针对对发生IOP升高的敏感性相对较低的患者(那些基线IOP<22mmHg并且没有IOP事件病史的患者)。根据他们的第一次植入后眼压检查,该算法将其分类为:如果IOP保持<22mmHg,则为低危;如果IOP为22~25mmHg,则为中危,且任何高于基线的升高均<10mmHg;如果IOP>25mmHg或高于基线的升高均为≥10mmHg,则为高危.此后,算法指导这些组中每个组所需的监测频率和程度,如果眼压在治疗期间上升或下降,患者可以相应地向上或向下移动风险组。为更容易发生IOP升高的患者(基线IOP≥22mmHg或先前有IOP事件史的患者)提供了不同的算法。这些患者需要更密切地监测,因此该算法仅具有中风险或高风险分类。这些算法更新了Goñi等人先前的监测指导。(戈尼等人。在OthalmorTher5:47-61,2016中)。
一些糖尿病患者有黄斑水肿,这是视网膜中央部分(位于眼睛后部的组织)的肿胀。如果不治疗,这种肿胀会威胁视力。将诸如皮质类固醇之类的药物注入眼睛可以帮助治疗该病症。有时这具有增加眼内压(眼内压力)的副作用。小的或短暂的眼压上升应该没有理由担心,但是确保压力不会太高太长时间是非常重要的-因为这可能导致视力丧失。为了防止这种情况发生,眼科医生需要定期检查眼压。有些人更容易受到这个问题的影响-例如,过去有任何与眼压有关的问题的人,或者在治疗前眼睛压力已经高于正常水平的人。最易受影响的人可能需要更多类型的检查和更频繁的检查,以确保快速发现和治疗任何问题。我们开发了流程图,帮助眼科医生决定哪些检查是需要的,以及根据医生在治疗前对人的眼睛的了解以及他们在治疗后的每次检查中看到的情况而定的频率。他们帮助医生确保每个人都在正确的时间进行检查,并帮助医生及早发现任何问题,以便在长期损害发生之前解决这些问题。
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