阿弗利百普与地塞米松治疗对糖尿病黄斑水肿患者视网膜外膜形成的影响

IF 2.6 3区医学 Q2 OPHTHALMOLOGY

Ophthalmology and Therapy Pub Date : 2024-12-01 Epub Date: 2024-10-25 DOI:10.1007/s40123-024-01057-z

Hsin-Ho Chang, Sheng-Chu Chi, Shih-Jen Chen, Yu-Bai Chou, Tai-Chi Lin

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引用次数: 0

摘要

简介本研究旨在探讨阿弗利百普（aflibercept）和地塞米松（DEX）对糖尿病性黄斑水肿（DME）患者视网膜外膜（ERM）形成的影响及其治疗效果：在这项回顾性队列研究中，对2017年6月至2019年6月期间确诊为DME的429名患者的124只眼睛的病历进行了回顾。患者分为两组：aflibercept组（67眼）和DEX组（57眼）。主要终点是玻璃体内治疗后的继发性 ERM 发生率及其与不同药物的相关性。次要终点包括最佳矫正视力（BCVA）和黄斑中心厚度（CMT）的纵向变化：在24个月的随访中，与阿弗利贝赛相比，接受DEX治疗的眼睛发生ERM的几率高出约4倍[危险比（HR）=3.97，P=0.02]。在生存分析模型中，尽管需要的总注射次数较少（p = 0.000），但这些眼睛的BCVA（p = 0.059）和CMT（p = 0.004）也较差。ERM 形成的累积概率为 13.7%。此外，DME 眼球在发生 ERM 后，功能和解剖结果都很差，而年龄、A1c 水平、DR 严重程度、初始 BCVA 和 CMT、晶状体状态和既往激光治疗与 ERM 形成的高发生率无关：结论：与阿弗利贝赛相比，在DME眼球内植入DEX会在两年内导致更高的继发性ERM形成率。ERM形成后，对DME的疗效会减弱，导致更差的解剖结果。应探索新的治疗方法，以防止 ERM 的形成，同时保持 DME 治疗的解剖和功能效果。

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Impact of Aflibercept vs Dexamethasone Treatment on Epiretinal Membrane Formation in Eyes with Diabetic Macular Edema.

Introduction: This study aimed to investigate the impact of aflibercept and dexamethasone (DEX) on the formation of epiretinal membrane (ERM) and their treatment outcomes in eyes with diabetic macular edema (DME).

Methods: In this retrospective cohort study, medical records of 124 eyes from 429 patients diagnosed with DME were reviewed between June 2017 and June 2019. Patients were categorized into two groups: the aflibercept group (67 eyes) and the DEX group (57 eyes). The primary endpoint was the secondary ERM incidence following intravitreal treatments and its correlation across different medications. Secondary endpoints included longitudinal changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT).

Results: Over a 24-month follow-up, eyes treated with DEX had approximately a fourfold higher incidence of ERM development compared to aflibercept [hazard ratio (HR) = 3.97, p = 0.02]. These eyes also showed worse BCVA (p = 0.059) and increased CMT (p = 0.004), despite requiring fewer total injections (p = 0.000) in the survival analysis model. The cumulative probability of ERM formation was 13.7%. Additionally, DME eyes exhibited poor functional and anatomical outcomes after developing ERM, while age, A1c level, DR severity, initial BCVA and CMT, lens status, and previous laser treatment were not associated with an elevated incidence of ERM formation.

Conclusion: Intravitreal DEX implantation in DME eyes resulted in a higher incidence of secondary ERM formation compared to aflibercept over a 2-year period. The therapeutic efficacy for DME was diminished following ERM development, leading to worse anatomical outcomes. New therapeutic approaches should be explored to prevent ERM formation while maintaining both anatomical and functional outcomes in DME treatment.

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来源期刊

Ophthalmology and Therapy OPHTHALMOLOGY-

CiteScore

4.20

自引率

3.00%

发文量

157

审稿时长

6 weeks

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