■糖尿病性黄斑水肿(DME)是视力损害的重要原因,由于不同的反应和患者的多样性,对其管理提出了挑战。虽然抗血管内皮生长因子(抗VEGF)药物彻底改变了DME治疗,一些患者不适合这种治疗。玻璃体内皮质类固醇治疗,例如地塞米松植入物(DEX),已经成为一种选择。本研究旨在全面探讨玻璃体内DEX在有抗VEGF治疗禁忌症的未治疗DME患者中的作用。白内障手术前一个月给药。
■一项单中心回顾性研究包括20只患有糖尿病的眼睛,视觉上明显的白内障,未经处理的DME,和抗VEGF治疗的全身禁忌症。患者接受DEX治疗,然后在一个月后进行白内障手术。最佳矫正视力(BCVA),黄斑中心厚度(CMT),在多个时间点评估眼内压(IOP)。
■在DEX后第30、90和180天,BCVA显着改善(P<0.00001)。CMT在第30天显示显着下降(P<0.00001),持续到90和180天(P<0.00001)。在第90天,在25%的眼睛中观察到复发性DME。眼压在第30天(P<0.00001)和第90天(P=0.0006)显著增加,在第180天返回基线。然而,只有两只眼睛需要局部抗青光眼治疗。未发现其他眼部或全身不良事件。
■白内障手术前1个月给予玻璃体内注射DEX,为有全身抗VEGF治疗禁忌症的未治疗DME患者提供了一种有希望的治疗策略。这项研究的发现提供了提高视力和减少黄斑厚度的见解,以及可管理的IOP更改。这种个性化的方法是DME管理的宝贵补充,特别是对于复杂的医疗案例,保证进一步的研究和临床实践的考虑。
UNASSIGNED: Diabetic macular edema (DME) is a significant cause of vision impairment, posing challenges in its management due to variable responses and patient diversity. While anti-vascular endothelial growth factor (anti-VEGF) agents have revolutionized DME treatment, some patients are not suitable candidates for this therapy. Intravitreal corticosteroid therapy, such as the dexamethasone implant (DEX), has emerged as an alternative. This study aimed to comprehensively investigate the role of intravitreal DEX in treatment-naive DME patients with systemic contraindications to anti-VEGF therapy, administered one month before cataract surgery.
UNASSIGNED: A single-center retrospective study included 20 eyes with controlled diabetes, visually significant cataracts, untreated DME, and systemic contraindications for anti-VEGF therapy. Patients underwent DEX treatment followed by cataract surgery after one month. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were assessed at multiple time points.
UNASSIGNED: BCVA significantly improved on days 30, 90, and 180 post-DEX (P<0.00001). CMT showed a significant decrease at day 30 (P<0.00001), which was sustained through days 90 and 180 (P<0.00001). Recurrent DME was observed in 25% of eyes on day 90. IOP increased significantly at days 30 (P<0.00001) and 90 (P=0.0006), returning to baseline by day 180. However, only two eyes needed topical anti-glaucoma treatment. No other ocular or systemic adverse events were noted.
UNASSIGNED: Intravitreal DEX administered one month before cataract surgery offers a promising treatment strategy for treatment-naive DME patients with systemic contraindications to anti-VEGF therapy. The study\'s findings provide insights into improving visual acuity and reducing macular thickness, along with manageable IOP changes. This personalized approach is a valuable addition to DME management, especially for complex medical cases, warranting further research and consideration for clinical practice.