目的这项研究的目的是研究类固醇转换的时机对糖尿病性黄斑水肿(DME)眼的视觉和解剖学结果的影响,这些糖尿病性黄斑水肿对多种玻璃体内抗血管内皮生长因子(抗-VEGF)注射反应不足。在DME的治疗中,抗VEGF注射通常是最初的作用过程。然而,在DME持续的情况下,尽管抗VEGF治疗,玻璃体内地塞米松植入物(Ozurdex®,AllerganInc.,Irvine,CA)经常被利用。尽管如此,对于过渡到类固醇治疗的最佳时机仍缺乏共识.这项研究旨在阐明在顽固性DME的情况下调整类固醇转换时间的潜在好处。方法回顾性分析77例顽固性DME患者(n=105)眼,介入,包括三组的比较研究:参与者在三次抗VEGF注射后转换为类固醇植入物(组I),四到六次抗VEGF注射(第二组),和超过六个抗VEGF注射(组III)。抗VEGF治疗失败定义为中央视网膜厚度(CRT)≥300微米和/或缺乏视觉改善(根据Snellen视力≤1行视觉增益)。最后一次随访在注射Ozurdex®10-12周后进行。结果19眼(46%)改善,17眼(50%),第一组有10只眼(33%),II,III,分别,改用地塞米松植入物后。在第二组(32只眼,94%)。在所有三组中,CRT的降低具有统计学意义。结论玻璃体腔注射地塞米松可改善抗VEGF抵抗DME眼的功能和形态学结果。注射四到六次抗VEGF后,转换为类固醇植入物可获得最佳功能效果.
Purpose The purpose of this study is to examine the impact of the timing of the steroid switch on both visual and anatomical outcomes in diabetic macular edema (
DME) eyes that have shown an inadequate response to multiple intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. In the treatment of
DME, anti-VEGF injections are typically the initial course of action. However, in cases where
DME persists despite anti-VEGF treatment, intravitreal dexamethasone implants (Ozurdex®, Allergan Inc., Irvine, CA) are often utilized. Despite this, there remains a lack of consensus regarding the optimal timing for transitioning to steroid treatment. This study aims to shed light on the potential benefits of adjusting the timing of the steroid switch in cases of recalcitrant
DME. Methods The eyes (n = 105) of 77 patients with recalcitrant
DME were included in this retrospective, interventional, comparative study comprising three groups: participants switched to steroid implants after three anti-VEGF injections (Group I), four to six anti-VEGF injections (Group II), and more than six anti-VEGF injections (Group III). Anti-VEGF treatment failure was defined as a central retinal thickness (CRT) of ≥300 microns and/or a lack of visual improvement (≤1 line of visual gain according to Snellen acuity). The last follow-up took place after 10-12 weeks of Ozurdex® injections. Results Improvement was observed in 19 eyes (46%), 17 eyes (50%), and 10 eyes (33%) in Groups I, II, and III, respectively, after switching to dexamethasone implants. The best overall results (an improvement in vision and stabilization) were seen in Group II (32 eyes, 94%). The decrease in CRT was statistically significant in all three groups. Conclusion Intravitreal dexamethasone implants improved functional and morphological outcomes in anti-VEGF-resistant DME eyes. After four to six anti-VEGF injections, switching to a steroid implant resulted in the best functional results.