Al-Khersan, H., Hariprasad, S.M., Chhablani, J.
期刊名称：American journal of ophthalmology
地塞米松 玻璃体 黄斑
摘要：目的：旨在探讨糖尿病性黄斑水肿（DME）患者玻璃体内注射地塞米松的早期视力反应是否与长期预后相关。设计：回顾性病例系列研究。方法：多中心（8处）回顾性分析0.7mg玻璃体内地塞米松植入物治疗DME眼，且随访最少18个月的病历。包括120只眼。玻璃体视网膜界面异常或玻璃体切除术患者排除在外。根据3个月内最佳矫正视力（BCVA）变化（logMAR等效值改善<5个字母，5-9个字母或≥10个字母）将眼分成3组。每个早期应答组确定视力预后。采用回归分析评估早期（3个月）和总体变化之间的关系。结果：在研究人群（102只眼）中，3个月时<5个字母，5-9个字母和≥10个字母BCVA改善分别见于44.1％，18.6％和37.3％的眼。在3个月内次优（<5个字母）应答者中，研究结论中6.7％的患者显示≥10个字母改善，而强烈（≥10个字母）早期应答组中的患者则为29％（P = 0.009）。 3个月BCVA变化与BCVA整体变化呈显着正相关（系数= 0.44，P = .002）。结论：3个月时，表现出次优（<5个字母）和强烈（≥10个字母）早期反应眼比例相似。具有强烈早期反应的眼显示BCVA≥10个字母的长期增益明显高于早期反应差眼。早期治疗反应与BCVA的整体变化直接相关。
PURPOSE:To determine whether early visual acuity response to intravitreal dexamethasone implant therapy in diabetic macular edema (DME) is associated with long-term outcome.DESIGN:Retrospective case series.METHODS:Multicenter (8 sites) retrospective review of medical records of eyes with DME treated with 0.7mg intravitreal dexamethasone implant and minimum 18-month follow-up. One hundred and two eyes were included. Eyes with vitreoretinal interface abnormalities or that had undergone vitrectomy were excluded. Eyes were categorized into 3 groups based on change in best-corrected visual acuity (BCVA) at 3months (logMAR equivalence of <5-letter, 5-9-letter, or ≥10-letter gain). Visual acuity outcomes were determined for each early response group. The relationship between early (3-month) and overall change in BCVA was assessed using regression analysis.RESULTS:In the study population (102 eyes), <5-letter, 5- to 9-letter, and ≥10-letter BCVA improvements were seen in 44.1%, 18.6%, and 37.3% of eyes, respectively, at 3months. Among suboptimal (<5-letter) responders at 3months, 6.7% showed ≥10-letter gains at study conclusion compared to 29% in the robust (≥10-letter) early response group (P=.009). Change in BCVA at 3months showed significant positive correlation with overall change in BCVA (coefficient= 0.44, P= .002).CONCLUSIONS:A similar proportion of eyes demonstrated suboptimal (<5-letter) and robust (≥10-letter) early response to treatment at 3months. Eyes with a robust early response demonstrated ≥10-letter long-term gain in BCVA at a significantly higher rate compared to those with poor early response. Early treatment response directly correlated with overall change in BCVA.