白内障乳化术前应用非甾体类抗炎药预防黄斑囊样水肿的临床观察

目的 探讨白内障乳化术前应用非甾体类抗炎药预防黄斑囊样水肿的临床效果.方法 120例白内障患者参照抽签法分作对照组与研究组,每组60例,2组患者均予以白内障超声乳化吸除术,对照组予以妥布霉素地塞米松滴眼液(典舒)辅助治疗,研究组基于对照组予以普拉洛芬滴眼液辅助治疗,观察2组患者术后黄斑囊样水肿的发生率、房水闪辉分级、黄斑中心凹厚度、眼压、体征与症状综合评分.结果 术后7、14 d,研究组黄斑囊样水肿的发生率低于对照组,差异有统计学意义(P<0 U.05);术后7、14 d,研究组房水闪辉分级均优于对照组,差异有统计学意义(P<0.05);术后14 d,研究组黄斑中心凹厚度、眼压、体征与症状综合评分均低于对照组,差异有统计学意义(P<0.05).结论 白内障乳化术患者术前运用非甾体抗炎药的抗炎效果确切,能够有效降低黄斑囊样水肿的发生率,利于患者恢复,值得推广.     

Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery

ABSTRACT

Introduction: Cataracts and diabetes are widespread pathologies that are of growing concern to the global population. In diabetic patients who have had cataract surgery, the worsening of preexisting diabetic macular edema or occurrence of pseudophakic cystoid macular edema are common causes of visual impairment even with the most advanced surgical techniques available today for phacoemulsification.

Areas covered: In this review, the authors assess the available literature to evaluate and compare different drugs, with the aim of establishing the best pharmacological strategies for the prevention and treatment of macular edema in diabetic patients undergoing cataract surgery.

Expert opinion: Guidelines for the optimal management of diabetic macular edema in conjunction with cataract surgery or treatment of pseudophakic cystoid macular edema in diabetic patients are still lacking. To treat these conditions, clinicians need to understand the pharmacokinetics, posology, and efficacy of available drugs: topical non-steroidal anti-inflammatory drugs (NSAIDs), intravitreal anti-vascular endothelial growth factors (VEGFs), and both topical and intravitreal steroids. Diabetic patients undergoing cataract surgery should receive topical NSAIDs to prevent pseudophakic cystoid macular edema. Intravitreal anti-VEGFs and steroids, in association with cataract surgery, are indicated for patients with preexisting diabetic macular edema or those at high risk of macular edema after surgery.     

Fluocinolone acetonide for the treatment of diabetic macular edema

Introduction: Fluocinolone acetonide intravitreal implant is a non-erodible implant approved for the treatment of diabetic macular edema (DME) insufficiently responsive to available therapies.

Areas covered: The injectable intravitreal implant releases fluocinolone acetonide at an average rate of 0.2 µg/day for at least 36 months. The two pooled pivotal FAME trials showed that, in patients with DME previously treated with laser photocoagulation, fluocinolone acetonide intravitreal implant was more beneficial than sham injection when looking at the proportion of patients with an improvement from baseline in visual acuity of more than 15 letters at 24 months and at 36 months. Cataract (82%) and intraocular pressure (IOP) elevation (37%) were the most common adverse events. Raised IOP was mostly treated with IOP-lowering medications, with <5% of eyes requiring incisional IOP-lowering surgery. FAME trial program results are confirmed by a series of real-world studies in eyes with chronic/recalcitrant DME.

Expert opinion: data indicate that fluocinolone acetonide intravitreal implant is a useful second-line option for the treatment of DME.     

Fluocinolone acetonide for the treatment of diabetic macular edema

In addition to VEGF inhibitors such as ranibizumab, aflibercept or bevacizumab, clinical and experimental investigations have revealed the great potential of steroids in the treatment of DME. At present two intravitreal steroid inserts are approved for the treatment of DME containing either dexamethasone or fluocinolone acetat (FA) as a pharmacological compound. The non degradable intravitreal FA insert releases 0.2 µg FA per day (Iluvien, Alimera Sciences). Clinical phase III studies have demonstrated the beneficial effect of the FA insert to last up to three years, especially in patients with a prolonged history of DME of at least three years at the initiation of therapy. While the treatment appears to be well tolerated over all, side effects such as cataract formation in nearly all treated phakic patients and raise of intraocular pressure need to be discussed with the patients as potential complications of the treatment.     

Current concepts of pharmacotherapy of diabetic macular edema

ABSTRACT

Introduction: Diabetic macular edema (DME) is a sight threatening disease and a major cause for blindness for people in working age. The pathogenesis is multifactorial and complex. The pharmacotherapy of DME addresses both the inhibition of vascular endothelial growth factor (VEGF) by the intravitreal injection of VEGF inhibitors and inflammatory processes by the intravitreal application of steroids. Several trials have been published reporting on the efficacy and safety of these treatments.

Areas covered: This review discusses original research articles including basic science and clinical studies as well as review articles focusing on the role of inflammation and VEGF expression in DME. It discusses newly published clinical trials on intravitreal pharmacotherapy for DME. The literature was searched using Medline/PubMed and was selected given its relevance for the topic to be discussed.

Expert opinion: Our knowledge regarding the pathophysiology of diabetic macular edema has significantly increased. Some of these insights have been successfully transferred into current treatment strategies already including VEGF suppression or anti-inflammatory treatments using steroids. The identification of additional pathophysiological aspects and their relevance as potential treatment targets will be a future challenge in the treatment of DME. A better knowledge on the complex pathophysiology will also help to establish combination strategies.     

Emerging drugs for diabetic macular edema

Introduction: Diabetic macular edema (DME) is the most common cause of visual impairment due to diabetic retinopathy. The treatment of DME has recently undergone a paradigm shift. Traditionally, photocoagulation was standard treatment, but pharmacologic therapies are becoming increasingly used for this purpose. All currently available drug therapies for DME are either anti-VEGF agents or corticosteroids.

Areas covered: The pathogenesis of DME involves angiogenesis, inflammation and oxidative stress. The scientific rationale to treat DME through the pharmacologic blockade of VEGF and other pro-angiogenic factors is discussed. The fluocinolone insert is approved for the treatment of DME in several European countries, but not in the US at this time. Some medications that are already approved for other retinal diseases, most prominently aflibercept and the dexamethasone delivery system, have recently obtained approval for DME in the US. Other compounds are being studied in earlier-phase clinical trials.

Expert opinion: Pharmacologic treatment of DME will likely become increasingly used, especially for patients with edema involving the fovea. At this time, the two main classes of medication for treatment of DME are anti-VEGF agents and corticosteroids. As we continue to collect clinical trials data, the precise role of individual agents, and the continuing role for photocoagulation, will become more clear.     

Intravitreal bevacizumab and dexamethasone implant for treatment of chronic diabetic macular edema

Objective: To evaluate anatomical and functional outcomes of intraviteal bevacizumab (IVB) in patients with chronic diabetic macular edema (DME), and the effectivity and safety of dexamethasone implant in those unresponsive to regular IVB treatment. Methods: Thirty-five eyes of 35 patients (16 male and 19 female) with chronic DME (central foveal thickness (CFT) >?275?μm, duration >?6 months) received three injections of 2.5?mg IVB with six-week intervals. At 18 weeks, dexamethasone implant was applied to patients unresponsive to IVB. Main outcomes were the change in best corrected visual acuity (BCVA), CFT and ocular and systemic adverse effects for both drugs. The patients responsive to IVB were followed up for 36 weeks and those patients receiving dexamethasone implant were followed up for 24 weeks postoperatively. Results: At 18 weeks, the mean BCVA (0.68?±?0.40 logMAR, p?=?0.45) and CFT (453?±?169?μm, p?=?0.58) did not show any significant change compared to baseline (0.74?±?0.42 logMAR and 521?±?151?μm, respectively). In 20 patients (%57.1) responsive to IVB, the CFT was significantly improved from 12 to 36 weeks with the mean value of 295?±?42 μ (p?=?0.01). However, no significant difference was observed for BCVA during this period (p?=?0.17). Dexamethasone was implanted in 15 eyes (42.8%) unresponsive to IVB at 18 weeks. Statistically significant improvements were observed in BCVA (at postoperative 4 and 12 weeks) and CFT (at postoperative 4, 12 and 24 weeks). In addition, both parameters significantly worsened at 24 weeks compared to 12 weeks (p?<?0.001 and p?=?0.01, respectively). Conclusions: Patients with chronic DME should be followed in accordance with a fixed treatment protocol combining anti-VEGF and steroid treatments.     

芪明颗粒联合雷珠单抗治疗糖尿病性黄斑水肿的临床研究

目的探讨芪明颗粒联合雷珠单抗治疗糖尿病性黄斑水肿的临床疗效。方法选取2015年3月—2016年3月在上海市闵行区中心医院进行治疗的糖尿病性黄斑水肿患者90例,根据治疗方案的差别分为对照组(45例)和治疗组(45例)。对照组患者玻璃体腔内注射雷珠单抗注射液,0.5 mg/次,1次/月。治疗组在对照组的基础上口服芪明颗粒,1袋/次,3次/d。两组患者均连续治疗6个月。评价两组患者临床疗效,比较治疗前后两组患者最佳矫正视力(BCVA)、黄斑中央视网膜厚度(CMT)和玻璃体液中细胞因子。结果治疗后,对照组的总有效率为80.00%,显著低于治疗组的95.56%,两组比较差异具有统计学意义(P0.05)。治疗后,两组血管内皮生长因子(VEGF)和白细胞介素-6(IL-6)水平均明显降低,而色素上皮衍生因子(PEDF)水平显著升高,同组比较差异具有统计学意义(P0.05);且治疗后治疗组上述指标水平显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组BCVA显著升高,CMT显著降低,同组比较差异具有统计学意义(P0.05);且治疗后治疗组BCVA和CMT改善更显著,两组比较差异具有统计学意义(P0.05)。结论芪明颗粒联合雷珠单抗治疗糖尿病性黄斑水肿效果显著,可明显改善患者视力,促进黄斑水肿恢复,具有一定的临床推广应用价值。     

倍频Nd:YAG激光治疗糖尿病性黄斑水肿的临床分析

目的:探讨倍频Nd:YAG激光治疗糖尿病性黄斑水肿的临床效果。方法:对218例(364只眼)分别为局限性黄斑水肿、弥漫性黄斑水肿、囊样黄斑水肿的糖尿病性视网膜病变患者行倍频Nd:YAG激光治疗。对局限性黄斑水肿采用局部光凝,对弥漫性、囊样黄斑水肿采用格栅状光凝。根据不同病变类型选择激光参数,激光后3个月复查视力、荧光血管造影,观察黄斑水肿消退情况。随诊3~39个月。结果:局限性黄斑水肿142只眼,光凝后视力保持不变和提高者139只眼,占97.89%,水肿全部或部分吸收者139只眼,占97.89%;弥漫性黄斑水肿157只眼,光凝后视力保持不变和提高者144只眼,占91.72%,水肿全部或部分吸收者146只眼,占92.99%;囊样黄斑水肿65只眼,光凝后视力保持不变和提高者53只眼,占81.54%,水肿全部或部分吸收者59只眼,占90.77%。结论:根据黄斑水肿类型、视力情况选择激光参数,确保光斑有效,同时治疗糖尿病及其并发症,是激光治疗糖尿病性黄斑水肿的关键。     

球后注射曲安奈德联合激光光凝治疗糖尿病弥漫性黄斑水肿的疗效观察

目的 观察曲安奈德（TA）球后注射联合格栅样光凝（MLG）治疗糖尿病性弥漫性黄斑水肿（DME）的疗效.方法 以50眼糖尿病性DME为研究对象,30眼给予球后注射TA联合MLG,20眼给予单纯MLG,治疗6个月内,观察患眼视力、黄斑水肿以及黄斑中心凹视网膜厚度.结果 TA联合MLG组患者视力提高21眼,视力不变6眼,视力下降3眼;黄斑中心凹区视网膜厚度治疗前为（598.62±198.58） μm,治疗6个月后（307.51±101.21） μm.MLG组视力提高2眼,视力不变10眼,视力下降8眼;黄斑中心凹区视网膜厚度治疗前为（574.73±187.12） μm,治疗6个月后（369.12±112.20） μm.两治疗组间治疗后有统计学差异.结论 TA球后注射联合MLG治疗糖尿病DME可改善视力、促进黄斑水肿吸收.     

玻璃体腔注射康柏西普治疗糖尿病性和视网膜静脉阻塞性黄斑水肿的疗效对比观察

目的：对比研究糖尿病和视网膜静脉阻塞继发黄斑水肿患者玻璃体腔注射康柏西普治疗临床疗效差异。方法：选取自2016年3月-2017年10月收入某院行玻璃体腔注射康柏西普治疗糖尿病性黄斑水肿者21例/30只眼,视网膜静脉阻塞性黄斑水肿者35例/35只眼。回顾性对比观察这2组患者治疗后1个月、3个月及末次随诊时者最佳矫正视力（BCVA）和中央黄斑区视网膜厚度（CMT）及其变化,以及治疗有效率、黄斑水肿复发率、治疗病程和注药次数等,采用方差分析的方法对这些指标进行组间和组内统计学比较。结果：比较康柏西普玻璃体腔内注射治疗后1个月、3个月及末次随访时与治疗前基线的BCVA差值（ΔBCVA）和CMT差值（ΔCMT）,静脉阻塞组均高于糖尿病组并具有显著性（P<0.05）。静脉阻塞组和糖尿病组治疗有效率分别为100%和86.7%,复发率为14.3%和20.0%;静脉阻塞组和糖尿病组的患者治疗病程分别为（4.40±1.90）个月和（5.72±3.03）个月,注药次数为（2.51±0.74）次和（3.07±1.34）次,均具有显著性（P<0.05）。所有患者治疗随访过程中未见明显与药物、玻璃体腔注射相关的眼部和全身不良事件的发生。结论：玻璃体腔内注射康柏西普治疗视网膜静脉阻塞性和糖尿病性黄斑水肿均有较好疗效,但静脉阻塞患者其黄斑水肿消退和视力提升更为显著和迅速,而糖尿病患者治疗病程更长,需要更多次（3次以上甚至更多次）注药才能控制黄斑水肿的病情。     

羟苯磺酸钙胶囊联合雷珠单抗治疗糖尿病视网膜病变黄斑水肿的临床研究

目的观察羟苯磺酸钙联合雷珠单抗治疗糖尿病视网膜病变黄斑水肿的临床疗效和安全性。方法将76例糖尿病视网膜病变黄斑水肿患者随机分为对照组和试验组,每组38例。对照组给予羟苯磺酸钙每次500 mg,每天3次,口服;试验组在对照组治疗的基础上,给予雷珠单抗每次0. 5 mg,玻璃体腔内注射,每隔4周重复注射1次,共治疗3次。比较2组患者的临床疗效、最佳矫正视力(BCVA)、黄斑中心厚度(CMT)及血清血管内皮生长因子(VEGF)、促血管生成素1(Ang^-1)、促血管生成素2(Ang-2)和药物不良反应发生情况。结果治疗后,对照组总有效率为78. 95%(30例/38例),试验组为94. 74%(36例/38例),差异有统计学意义(P <0. 05)。治疗后,对照组和试验组血清VEGF分别为(125. 62±25. 67)和(92. 34±22. 79)μg·L^-1,血清Ang^-1分别为(10. 62±2. 37)和(13. 89±2. 58)μg·L^-1,血清Ang-2分别为(5. 29±1. 05)和(4. 23±0. 94)μg·L^-1,BCVA分别为0. 61±0. 16和0. 73±0. 15,CMT分别为(265. 41±62. 34)和(203. 17±54. 78)μm,差异均有统计学意义(均P <0. 05)。对照组的药物不良反应发生率为10. 53%(4例/38例),试验组为15. 79%(6例/38例),差异无统计学意义(P> 0. 05)。结论羟苯磺酸钙联合雷珠单抗对糖尿病视网膜病变黄斑水肿的临床疗效确切,有助于改善眼底循环,提高视力。     

Retinal thickness fluctuations in patients receiving fluocinolone acetonide implant for diabetic macular edema

Abstract

Objectives: To evaluate central foveal thickness (CFT) variability and accompanying changes in visual acuity (VA) 12?months before and after treatment with the 190?mcg fluocinolone acetonide (FAc) intravitreal implant for diabetic macular edema (DME).

Methods: The Iluvien Clinical Evidence cohort study in the United Kingdom (ICE-UK) investigated the effectiveness of the FAc implant in people treated at 13 hospitals from April 2013 to April 2015. The following parameters were calculated for CFT for each patient: mean, standard deviation (SD), retinal thickness amplitude (RTA, the difference between maximum and minimum values), and coefficient of variation (CV).

Results: In 149 eyes with ≥2 CFT observations both before and after FAc implantation, the median VA was 50 ETDRS letters at implantation. Mean CFT was 487?µm at implantation and 135?µm at 12?months post-implant. Before implantation, the mean CV and mean SD for CFT were 24.6% and 112?µm, respectively; the mean RTA was 254?µm. A statistically significant (p?<?.001) decrease in all three parameters was observed after implantation (18.3%, 68.2?μm and 146?μm, respectively). There was an association between CFT change between extremes and the corresponding change in VA (Pearson’s correlation coefficient, r = ?0.292, p?<?.001, prior to the implant; r = ?0.379, p?<?.001, post-implant).

Conclusions: After accounting for the reduction in CFT, retinal thickness stabilized following FAc implantation. There might be VA benefits in reducing variability in CFT over time. This merits further exploration but would require more frequent CFT observations in order to properly determine patterns of retinal thickness variability.     

芪明颗粒联合视网膜激光治疗糖尿病性黄斑水肿的疗效分析

目的 观察芪明颗粒联合激光治疗对糖尿病性黄斑水肿的疗效.方法 将患者随机分为2组,治疗组28例50眼,对照组26例48眼.2组均行光凝治疗,治疗组同时加服芪明颗粒.结果 治疗组和对照组患者治疗1个月、2个月时视力的变化差异无统计学意义(1个月时U=0.2785,P>0.05;2个月时U=0.2869,P>0.05).3个月时2组视力变化差异有统计学意义(U=2.2412,P<0.05).2组患者于治疗后3个月黄斑水肿消退情况,2组比较差异有统计学意义(3个月时U=2.1775,P<0.05).激光治疗3个月后2组患者1~2环(黄斑区)mfERG比较,与治疗前相比,2组患者a波、b波的振幅密度均增加,差异均有统计学意义(P<0.05),治疗后2组之间比较,1环a波的振幅密度治疗组优于对照组,差异有统计学意义(P<0.05),2组治疗前后1~2环(黄斑区)a波、b波的潜伏期与治疗前相比无明显变化(P>0.05).结论 芪明颗粒联合激光治疗可更有效地减轻糖尿病性黄斑水肿,改善患者视力.     

曲安奈德治疗重度糖尿病黄斑水肿的临床观察

目的研究玻璃体腔内注射曲安奈德(TA)治疗重度糖尿病黄斑水肿的有效性。方法对36例(42眼)重度糖尿病黄斑水肿的患者,行玻璃体腔内注射TA(进口)(4mg/0.1ml)的治疗方法。观察治疗前后的四个指标:最佳矫正视力、眼压、眼底荧光血管造影(FFA)、OCT检测黄斑中心凹厚度。随访时间6～12个月(平均9个月)。结果本组病例36例(42眼),年龄45～70岁(平均57岁),FFA检查治疗前黄斑荧光渗漏明显,治疗后渗漏明显减轻;OCT检测黄斑中心凹厚度,治疗前平均(579.5±65)μm,治疗随访6个月后平均(279±78)μm,差异有统计学意义(P<0.05);最佳矫正视力范围治疗前为0.01～0.2,平均0.1,治疗后为0.2～0.4,平均0.3,差异有统计学意义(P>0.05);所有患者眼压都有升高,升高值8.0～20.0mmHg(平均14.0mmHg),7例(7眼)超过正常眼压范围,经治疗,眼压控制,没有严重并发症发生。结论玻璃体腔注射TA是治疗重度糖尿病黄斑水肿的有效方法,患者的视力有轻度提高,治疗后患者FFA,黄斑区荧光素渗漏明显减轻,OCT检查,证实黄斑厚度明显减小。     

Upcoming therapeutic advances in diabetic macular edema: an intravitreal dexamethasone drug delivery system

Introduction: Diabetes mellitus, through its ophthalmic complications diabetic retinopathy and diabetic macular edema (DME), is a leading cause of vision loss in industrialized countries.

Areas covered: This review covers laser treatment, which is a standard treatment strategy that has proven efficacy and safety through large clinical trials in DME. Several intravitreal drug applications currently being investigated are also discussed.

Expert opinion: First results suggest that the administration of anti-VEGF compounds is effective for DME. However, frequent injections may compromise safety. In order to enhance patient compliance, sustained delivery systems are being evaluated as potential treatment approaches. So far, only steroids have been included as active in such non-biodegradable or biodegradable delivery systems. Non-biodegradable systems are more complicated to administer as surgery is required and they need to be retrieved at the end of treatment. Also, in some cases safety issues have arisen, especially around intraocular pressure control. A new biodegradable dexamethasone delivery system seems to show promising efficacy results in addition to a more favorable safety profile, which will potentially improve patient compliance. All new therapeutic approaches, alone and in combination, will need to demonstrate their efficacy and safety in DME in future trials.     

糖尿病黄斑水肿应用玻璃体内注射雷珠单抗、曲安奈德的疗效分析

目的 比较玻璃体内注射雷珠单抗、曲安奈德在糖尿病黄斑水肿中的临床疗效.方法 收集本院2014年10月至2015年10月入院的80例糖尿病黄斑水肿患者,随机分为两组,雷珠单抗组患者给予雷珠单抗治疗,曲安奈德组患者给予曲安奈德治疗,比较两组患者治疗前后最佳矫正视力、RNV渗透面积、黄斑区中心视网膜厚度、眼压与并发症等.结果 雷珠单抗组患者BCVA为(0.556±0.155),显著高于曲安奈德组的(0.409±0.143);RNV渗透面积为(5.405±3.274),显著低于曲安奈德组的(8.332±4.058);雷珠单抗组患者CMT为(289.231±64.040) μm,显著低于曲安奈德组的(370.127±88.172)μm;雷珠单抗组患者治疗后眼压为(15.157±2.351) mmHg,显著低于曲安奈德组(17.264±3.197)mmHg;两组比较,t=4.4897、3.550、4.695、3.358,差异有统计学意义(P＜0.01).结论 玻璃体内注射雷珠单抗在糖尿病黄斑水肿中的临床疗效更为显著,安全性较高,具有借鉴性.     

Intravitreal dexamethasone implant Ozurdex in the treatment of diabetic macular edema in patients not previously treated with any intravitreal drug: a prospective 12-month follow-up study

Abstract

Objective: To evaluate the mid-long-term efficacy and safety of the dexamethasone intravitreal (DEX) implant (Ozurdex¹) in naïve patients with diabetic macular edema (DME).

Methods: Prospective and single-center study conducted on consecutive patients with a diagnosis of DME, who received a DEX implant and were followed up for at least 12?months. The main outcomes measurements were the mean change in best corrected visual acuity (BCVA) and in foveal thickness (FT) as compared to the baseline values.

Results: Of the 84 screened patients 50 were included in the study. The BCVA significantly improved from 52.4 (20.4) letters at baseline to 62.6 (15.6), 61.2 (18.4), 61.6 (18.6), 60.6 (19.0), and 60.6 (18.8) at 2, 4, 6, 12?months and end of follow-up period, respectively (repeated measures ANOVA and the Greenhouse-Geisser correction; p?=?.0008). At the end of the follow-up period, a gain of BCVA of ≥5, ≥10, and ≥15 letters were observed in 26 (52.0%), 18 (36.0%), and 16 (32.0%) patients, respectively. The mean FT was significantly reduced from 446.0 (139.9) µm at baseline to 327.2 (103.6) at the end of follow-up (repeated measures ANOVA and the Greenhouse-Geisser correction; p?=?.0008). During the study follow-up, the patients receive a mean of 3.4 (2.9–3.9) implants. Of the 32 phakic eyes at baseline, 17 (53.1%) either developed new lens opacity or progression of an existing opacity.

Conclusion: In eyes with DME not previously treated with intravitreal drugs, DEX implants provide meaningful functional and anatomical benefits, and these results are sustained mid–long-term.     

玻璃体内注射阿柏西普治疗顽固性糖尿病黄斑水肿的临床疗效分析

目的 探究玻璃体内注射阿柏西普治疗顽固性糖尿病黄斑水肿(DME)的临床疗效.方法 70例顽固性DME患者,随机分为对照组及观察组,每组35例.对照组玻璃体内注射雷珠单抗,观察组玻璃体内注射阿柏西普.对比两组黄斑中心凹视网膜厚度(CFT)、最佳矫正视力(BCVA)、眼压及不良反应发生情况.结果 术后1、2个月,两组CFT...     

Delivery of steroids into the eye for the treatment of macular edema

ABSTRACT

Introduction: Steroids have been in extensive use in ophthalmology since their discovery in 1948. Steroids are effective for the treatment of macular edema and may be delivered into the eye either topically, systemically, subconjunctivally, sub-Tenon, intravitreally and through injectable sustained release devices. Various steroid formulations and devices are commercially available. Each carries advantages and disadvantages, which requires the ophthalmologist to exercise careful medical judgment upon treatment selection.

Areas covered: This article focuses in steroid delivery into the eye for the treatment of macular edema, and reviews the current and future treatment options, summarizing their clinical efficacy and possible adverse effects.

Expert opinion: Steroids have an important role in the treatment of macular edema, regardless of its cause. Steroids are efficacious, low-cost, and much clinical experience has been accumulated regarding their use over the years. Prolonged systemic steroid use may be associated with severe systemic and local side effects, directly proportional to dosage and time. Intravitreal delivery of steroids has gained popularity as the medication is administered close to the target tissue, significantly reducing the possibility of systemic adverse effects. The biggest problem associated with intravitreal steroids still remains unacceptably high risk of glaucoma and cataract formation. Various controlled-release intravitreal delivery devices are currently commercially available, and more are in the pipeline. While they still carry the risk of local side effects, they are efficacious and can control macular edema for months and years after a single administration.