PDF(Pubmed)
Abstract：
Diabetic macular edema (DME) is a common sight-threatening complication of diabetic retinopathy (DR) and the leading cause of severe visual impairment among the working-age population. Several therapeutic options are available for the management of DME, including intravitreal corticosteroids. They have been traditionally used as second-line treatment, due to the risk of intraocular pressure increase and cataract-related adverse events. However, attention has recently been focused on the primary or early use of intravitreal corticosteroids, due to growing evidence of the crucial role of inflammation in the pathogenesis of DME. Furthermore, intravitreal steroid implants offer the additional advantage of a longer duration of action compared to anti-vascular endothelial growth factor agents (anti-VEGF). This review aims to summarize the available evidence on the efficacy and safety profile of dexamethasone (DEX) intravitreal implant, with a specific focus on clinical scenarios in which it might be considered or even preferred as first-line treatment option by adequate selection of patients, considering both advantages and possible adverse events. Patients with contraindications to anti-VEGF, DME with high inflammatory OCT biomarkers, pseudophakic patients and phakic patients\' candidates to cataract surgery as well as vitrectomized eyes may all benefit from first-line DEX implant. Additionally, DME not responders to anti-VEGF should be considered for a switch to DEX implant and a combination therapy of DEX implant and anti-VEGF could be a valid option in severe and persistent DME.
摘要：
糖尿病性黄斑水肿（DME）是糖尿病性视网膜病变（DR）的常见威胁视力的并发症，也是工作年龄人群中严重视力障碍的主要原因。有几种治疗选择可用于DME的管理，包括玻璃体内皮质类固醇.它们传统上被用作二线治疗，由于眼内压升高和白内障相关不良事件的风险。然而,最近注意力集中在玻璃体内皮质类固醇的主要或早期使用，由于越来越多的证据表明炎症在DME的发病机制中起着至关重要的作用。此外，与抗血管内皮生长因子试剂(抗VEGF)相比,玻璃体内类固醇植入物提供更长的作用持续时间的额外优点。这篇综述旨在总结地塞米松（DEX）玻璃体内植入的有效性和安全性的现有证据。特别关注临床方案，在这些方案中，通过适当选择患者，可以考虑甚至首选作为一线治疗方案，同时考虑优势和可能的不良事件。有抗VEGF禁忌症的患者，DME与高炎性OCT生物标志物，行白内障手术的假性晶状体患者和有晶状体眼患者以及玻璃体切除的眼都可能受益于一线DEX植入。此外,DME对抗VEGF无反应者应考虑转换为DEX植入物，DEX植入物和抗VEGF的联合治疗可能是严重和持续性DME的有效选择。
