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地塞米松植入用于治疗视网膜中央静脉阻塞后外层视网膜层的变化

Battaglia, P.M., Iacono, P., Scaramuzzi, M., Bandello, F.

期刊名称:Retina

卷期:2017年第37卷第10期

摘要

摘要:目的:旨在分析地塞米松注射治疗视网膜中央静脉阻塞(CRVO)继发性黄斑水肿后视网膜光学相干断层扫描显示的外视网膜层变化。方法:进行了一项前瞻性研究,对30CRVO相关黄斑水肿的患者(8 50岁以下患有非缺血性CRVO [<50-niVVO]患者,1250岁以上的niCRVO [> 50-niVVO]患者,10例缺血性CRVO [iCRVO]患者进行了研究。经过全面的眼科检查后,包括最佳矫正视力,荧光素血管造影术和光谱域光学相干断层扫描,每位患者接受了第一次植入。根据第四个月的黄斑水肿检测情况进行进一步的再治疗。主要预后指标为12个月检查时视网膜外层变化。结果:视网膜外层(外界膜,椭圆形区和视网膜色素上皮)分为不存在,中断或存在。<50--niCRVO组(没有患者缺乏外界膜,椭圆形区域,无视网膜色素上皮细胞层;25%和75%的病例分别存在和破坏外界膜;100%的病例存在破裂的椭圆形区和视网膜色素上皮)发现了最佳基线光学相干断层扫描图。而iCRVO组中的最差(40%,40%和10%的病例分别缺乏外界膜,椭圆形区和视网膜色素上皮) )。在所有CRVO亚组中观察到视网膜层明显恢复;<50-niVVO组改善最大。全组中位最佳矫正视力从0.85提高到0.45P = 0.0001)。值得注意的是,仅在基线时显示有或层中断的眼才能获得明显的最佳矫正视力,而与CRVO亚组检查无关,但基线层缺失眼无法获得任何改善。结论:地塞米松植入物可促进患有任何CRVO亚型患者的黄斑水肿消退,但在基线光谱相干层析成像显示,存在外视网膜层的眼可以实现有益的功能预后。

PURPOSE:To analyze the outer retinal layer changes on spectral-domain optical coherence tomography after dexamethasone implant for the treatment of macular edema secondary to central retinal vein occlusions (CRVO).METHODS:Thirty patients affected by macular edema related to CRVO (8 patients less than 50 years of age with nonischemic CRVO [<50-niCRVO], 12 patients more than 50 years with niCRVO [>50-niCRVO], and 10 patients with ischemic CRVO [iCRVO]) were included in a prospective study. After a comprehensive ophthalmologic examination, including best-corrected visual acuity, fluorescein angiography, and spectral-domain optical coherence tomography, each patient received a first implant. Further retreatments were performed on the basis of macular edema detection from the fourth month. Main outcome measure was the change in outer retinal layers at the 12-month examination.RESULTS:The retinal layers of interest (external limiting membrane; ellipsoid zone; and retinal pigment epithelium) were classified as absent, disrupted, or present. The best baseline optical coherence tomography profile was found in <50-niCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium layers in no patients; present and disrupted external limiting membrane in 25% and 75% of cases, respectively; disrupted ellipsoid zone and retinal pigment epithelium in 100% of cases), whereas the worst was detected in the iCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium in 40%, 40%, and 10% of cases, respectively). A significant recovery of the retinal layers was observed in all CRVO subgroups; the greatest improvement was found in <50-niCRVO group. Median best-corrected visual acuity in the whole group improved from 0.85 to 0.45 (P = 0.0001). It is noteworthy that a significant best-corrected visual acuity gain was achieved only in eyes showing present or disrupted layers at baseline regardless of the CRVO subgroup examined, whereas eyes with absent layers at baseline were unable to attain any improvement.CONCLUSION:Dexamethasone implant can promote the resolution of macular edema in patients affected by any CRVO subform, but a beneficial functional outcome could be achieved by eyes showing no absence of outer retinal layers on spectral-domain optical coherence tomography at baseline.


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