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玻璃体内注射地塞米松治疗糖尿病性黄斑水肿的早期反应可能预测视力预后

Al-Khersan, H., Hariprasad, S.M., Chhablani, J.

期刊名称:American journal of ophthalmology

卷期:2017年第184卷

摘要

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= 0.44P = .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BCVA10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.


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