在积极治疗方案下植入地塞米松的真实体验：ProDEX 研究。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina Pub Date : 2024-09-01 DOI:10.1016/j.oret.2024.03.019

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引用次数: 0

摘要

目的：评估在不同病因引起的黄斑水肿患者中，将玻璃体内地塞米松植入剂（DEX-植入剂）从临时治疗方案转为主动治疗方案的效果：设计：观察性、回顾性、非对照、多中心、全国性病例系列：方法：本研究纳入 2015 年 10 月至 2023 年 6 月期间接受治疗的 68 名患者的 81 只眼睛：本研究纳入了使用DEX-植入剂治疗糖尿病性黄斑水肿（DME）、视网膜静脉闭塞（RVO）、非感染性葡萄膜炎黄斑水肿（UME；包括手术后黄斑水肿）和放射性黄斑病变（RM）的从PRN方案转为主动方案的连续患者：主要结果指标：每次就诊时最佳矫正视力（BCVA）、黄斑中心厚度（CMT）和眼压（IOP）的变化：根据病因，DME 占 49.4%，UME 占 24.3%，RVO 占 21.0%，RM 占 6.2%。PRN和主动方案的平均（标清）随访时间分别为20.6（13.3）个月和14.2（10.3）个月。从PRN方案转为主动方案后，BCVA的平均（标度）显著提高了3.7（12.9）个ETDRS字母（p=0.01），CMT的平均（标度）下降了108.0（151.4）μm（p50μm），转为主动方案后，CMT的平均（标度）下降率也从40.1%降至6.0%（p结论：对于已经接受过 DEX-implant 治疗的患者，改用前瞻性方案似乎能显著改善 BCVA 和 CMT，同时保持眼压稳定。

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Dexamethasone Implant under a Proactive Treatment Regimen in a Clinical Setting

Purpose

To assess the effectiveness of switching intravitreal dexamethasone implants (DEX-implant) from pro re nata (PRN) treatment regimen to a proactive regimen in patients with macular edema of diverse etiologies.

Design

An observational, retrospective, uncontrolled, multicenter, national case series.

Participants

Eighty-one eyes from 68 patients treated between October 2015 and June 2023 were included.

Methods

This study included consecutive eyes treated with DEX-implant who were switched from a PRN regimen to a proactive regimen for diabetic macular edema (DME), retinal vein occlusion (RVO), noninfectious uveitis macular edema (UME; including postsurgical macular edema), and radiation maculopathy (RM).

Main Outcome Measures

The main outcome measures were change in the best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at each visit.

Results

According to the etiology, DME represented 49.4% of eyes, UME 24.3%, RVO 21.0%, and RM 6.2%. The mean (standard deviation [SD]) duration of follow-up under the PRN and proactive regimens was 20.6 (13.3) and 14.2 (10.3) months, respectively. Switching from a PRN to a proactive regimen significantly improved mean (SD) BCVA by 3.7 (12.9) ETDRS letters (P = 0.01) with a mean (SD) decrease in CMT of 108.0 (151.4) μm (P < 0.001). The proportion of visits with significant anatomic recurrence (> 50 μm) also decreased from 40.1% to 6.0% after switching to a proactive regimen (P < 0.001). The number of DEX-implant injections significantly increased during the proactive treatment period (P < 0.001), but the change in the number of visits was not significantly different (P = 0.2). The proactive treatment period was not associated with a significant increase in IOP (P = 0.6).

Conclusions

Switching to a proactive regimen in patients already treated with DEX-implant seems to significantly improve BCVA and CMT while maintaining stable IOP.