Intravitreal dexamethasone implant versus triamcinolone acetonide for macular oedema of central retinal vein occlusion: quantifying efficacy and safety.
Intravitreal dexamethasone implant versus triamcinolone acetonide for macular oedema of central retinal vein occlusion: quantifying efficacy and safety.
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DOI：
10.1186/s40942-018-0114-2
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发表时间：
2018
影响因子：
2.3
通讯作者：
Sharma V
中科院分区：
文献类型：
--
作者：
Mishra SK;Gupta A;Patyal S;Kumar S;Raji K;Singh A;Sharma V
在视网膜血管疾病中，视网膜静脉阻塞的负担是糖尿病视网膜病变后最常见的。玻璃体内皮质类固醇在治疗RVO黄斑水肿（ME）中越来越受欢迎。我们的研究比较了6个月内玻璃体内曲安奈德（IVTA）和地塞米松植入物（IVD）的有效性和安全性。这项比较性、前瞻性、随机研究对40例持续时间< 3个月的非缺血性中央RVO患者进行了显著ME（> 330 μm）。根据赫尔辛基宣言，研究于2012年9月至2014年5月在陆军研究医院进行。IVD组（n = 20）接受Ozurdex®，IVTA组（n = 20）接受曲安奈德（4 mg/0.1 ml），分别于第1天和第4、8、12、24周进行随访。6个月时，IVD组的最佳矫正视力和视网膜厚度（CMT）平均改善分别为0.43 logmar和323 μm，IVTA组分别为0.49 logmar和322 μm。两组中达到≥ 15个字母的患者比例约为40%。IVTA组在12周和24周时的IOP升高显著更高。IVTA组60%的患者眼压升高≥ 10 mmHg，其中41.6%的患者眼压升高> 35 mmHg，66%的患者需联合治疗，且6个月时眼压未达到基线。IVD组有5例患者出现眼压升高，均< 26 mmHg，单药治疗效果好，术后6个月眼压均达到基线水平。IVTA的IOP升高相对风险是IVD的2.4倍。IVTA组中白内障进展和白内障手术的发生率显著更高。在IVTA组中，35%的患者发生白内障进展，其中71.5%的患者在6个月时需要进行白内障手术。IVD组，10%的患者在6个月时发生白内障进展，而无患者需要手术。与IVD相比，IVTA的白内障进展相对风险高3.5倍。玻璃体内类固醇治疗视网膜静脉阻塞的黄斑水肿是有效的，而新配方的缓释地塞米松植入物比IVTA安全得多。
Among the retinal vascular diseases, burden of retinal vein occlusion is most common immediately after diabetic retinopathy. Intravitreal corticosteroids are gaining popularity in managing macular edema (ME) of RVO. Our study compares efficacy and safety of intravitreal triamcinolone (IVTA) and dexamethasone implant (IVD) over 6 months. This comparative, prospective, randomized study on 40 patients of non-ischemic central RVO with significant ME (> 330 μm) of < 3 months duration. Study was done at Army Research Hospital between Sep-2012 and May-2014 in accordance to Helsinki Declaration. IVD group (n = 20) received Ozurdex® while IVTA group (n = 20) received triamcinolone-acetonide (4 mg/0.1 ml), followed up at day-1 and weeks 4, 8, 12, 24. At 6 months, mean improvement in best corrected visual acuity and retinal thickness (CMT) in the IVD group was 0.43 logmar and 323 μm and in IVTA group was 0.49 logmar and 322 μm respectively. Proportion of patients achieving ≥ 15 letters was about 40% in both groups. IOP rise was significantly higher in IVTA group at 12 and 24 weeks. In IVTA group ≥ 10 mmHg IOP rise was seen in 60% of patients, 41.6% among them had > 35 mmHg and 66% needed combination treatment and failed to reach baseline line IOP at 6 months. In IVD group, 5 pts had IOP rise with all being < 26 mmHg and were easily managed with single agent with IOP reaching baseline by 6th month in all pts. Relative risk of IOP rise with IVTA is 2.4 times higher compared to IVD. Cataract progression and cataract surgeries were required at significantly higher rates in IVTA group. In IVTA group, cataract progression was seen in 35% patients, with 71.5% requiring cataract surgery at 6 months. IVD group, 10% patients had cataract progression while none required surgery at 6 months. Relative risk of cataract progression with IVTA is 3.5 times higher compared to IVD. Intravitreal steroids are effective in managing macular edema of retinal vein occlusion, while newer formulation of sustained release dexamethasone implant is significantly safer than IVTA.