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雷珠单抗早期应答预测地塞米松治疗无应答性糖尿病性黄斑水肿后的功能预后

Cicinelli, M.V., Cavalleri, M., Querques, L., Rabiolo, A., Bandello, F., Querques, G.

期刊名称:The British journal of ophthalmology

卷期:2017年第101卷第12期

摘要

摘要:目的:旨在分析玻璃体腔内注射地塞米松对糖尿病性黄斑水肿(DME)患者血管内皮生长因子(VEGF)负荷剂量下的视觉和功能反应的影响,以期对反应差患者早期转用糖皮质激素。设计:回顾性单中心研究。方法:对糖尿病患者三次雷珠单抗(RNB)注射后转为植入0.7 mg地塞米松种植体以及随访至12个月的数据进行回顾。主要观察指标为地塞米松注射后短期变化评估,根据RNB负荷剂量后最佳矫正视力(BCVA)和中心黄斑厚度(CMT)对患者分层。次要指标是调查长期随访中的临床获益维持情况。结果:45例患者(男23例,占51.1%),平均年龄(69.7±9)岁的45只眼纳入研究。注射RNB 3次后,30只眼(66.7%)视力反应差(-4.3±10.7字母),15只眼(33.3%)视力预后良好(+ 13.9±9.2字母)。视觉反应差患者伴有有限的形态改善(p = 0.04)。地塞米松1个月后,与良好视觉反应患者相比,只有不良反应患者表现出BCVA相对改善(p = 0.006)和CMT降低(p = 0.002),仅具有轻微的临床效果(p = 0.3)。平均1.9±1.1次地塞米松给药后,相同的趋势可维持至12个月。结果:RNB负荷剂量后的视觉和解剖学反应是对抗VEGF治疗无反应DME患者转用皮质激素后早期和长期视力改善的显着预测因素。

PURPOSE:To analyse the effects of intravitreal dexamethasone implant in patients suffering from diabetic macular oedema (DME) on the basis of their visual and functional response to antivascular endothelial growth factor (VEGF) loading dose, in order to early shift to corticosteroids in poorly responding patients.DESIGN:Retrospective monocentric study.METHODS:Data of patients with diabetes shifted to 0.7 mg dexamethasone implant after three injections of ranibizumab (RNB) and followed-up to 12 months were reviewed. Main outcome was the evaluation of short-term changes after dexamethasone implant injection, stratifying patients on the basis of best-corrected visual acuity (BCVA) and central macular thickness (CMT) after RNB loading dose. Secondary outcome was to investigate clinical gain maintenance at long-term follow-up.RESULTS:Overall, 45 eyes of 45 patients (23 males, 51.1%), mean age 69.7±9 years, were included in the analysis. After 3 injections of RNB, 30 eyes (66.7%) had a poor visual response (-4.3±10.7 letters), while 15 eyes (33.3%) disclosed good visual outcome (+13.9±9.2 letters). Patients with poor visual response were associated with limited morphological improvement (p=0.04). After 1 month from dexamethasone, only poor responders showed relevant increase in BCVA (p=0.006) and reduction in CMT (p=0.002), in comparison to good visual response patients, featuring only minor clinical effects (p=0.3). The same trend was maintained up to 12 months, after a mean of 1.9±1.1 dexamethasone administrations.CONCLUSION:Visual and anatomical responses after RNB loading dose are significant predictors of both early term and long-term visual acuity improvement after switching to corticosteroids in patients with DME unresponsive to anti-VEGF.


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