地塞米松玻璃体植入剂应用进展

地塞米松玻璃体植入剂(DEX)是一种装载0.7mg地塞米松的可生物降解的缓释植入物,其适应证主要有视网膜静脉阻塞继发黄斑水肿(RVO-ME)、糖尿病黄斑水肿(DME)和非感染性葡萄膜炎(NIU)。DEX的应用中不良事件主要有眼压升高和白内障,也正因此DEX在RVO-ME、DME的治疗中属于二线用药,多在抗血管内皮生长因子(VEGF)治疗无应答时使用,但DEX在人工晶状体眼或不愿频繁注药的患者中能发挥出其特定的优势。近来很多研究证实了DEX治疗NIU的有效性和安全性,但其在NIU治疗中的地位尚不明确。本文综述了DEX相关的重大临床试验结果,分析其应用进展和安全性。     

地塞米松玻璃体内植入剂治疗非感染性葡萄膜炎顽固性黄斑水肿

目的：观察地塞米松玻璃体内植入剂(IDI)治疗非感染性葡萄膜炎(NIU)顽固性黄斑水肿的有效性及安全性。

方法：选取2018-04/2020-06在新疆军区总医院北京路医疗区眼科确诊的NIU患者25例30眼,均进行玻璃体腔注射IDI治疗,观察治疗前后最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、玻璃体混浊程度评分及并发症等情况。

结果：首次玻璃体腔注射IDI治疗前,纳入患者BCVA(LogMAR)为0.76±0.37,CMT为480.03±96.72μm,玻璃体混浊程度评分为3.06±0.78分; 治疗后1、3、6mo,BCVA分别为0.61±0.24、0.53±0.10、0.40±0.13,均较治疗前明显改善(P<0.05),CMT分别为324.54±79.88、245.16±67.87、185.52±36.05μm,较治疗前明显降低(P<0.05),玻璃体混浊程度评分分别为2.31±0.64、1.37±0.76、0.82±0.42分,均较治疗前明显降低(P<0.05)。平均随访8.2±2.1mo,6眼眼压升高,经降眼压治疗后末次随访时处于正常范围; 3眼玻璃体腔重复注射IDI; 所有患者均无感染性眼内炎等并发症发生。

结论：玻璃体腔注射IDI治疗NIU继发的顽固性黄斑水肿具有良好的安全性及有效性,可有效降低CMT,减轻玻璃体炎症,改善视力。     

实验性自体免疫性葡萄膜炎的治疗研究进展

葡萄膜炎是眼科的一种常见致盲性眼病,目前治疗主要以皮质类固醇激素为主,但激素具有副作用大等缺点。自成功建立实验性自体免疫性葡萄膜炎模型以来,多种新型药物以及治疗方法均已得到实验应用,为临床治疗提供了可靠的依据。本文对近年来实验性自体免疫性葡萄膜炎的治疗研究进展进行了综述。     

阿达木单抗治疗非感染性葡萄膜炎

非感染性葡萄膜炎(non-infectious uveitis,NIU)是一组免疫介导的疾病,其病因复杂,治疗棘手。肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)是NIU中的主要促炎因子,阿达木单抗是一种完全的人源性TNF-α单克隆抗体,特异性与TNF-α结合阻断其诱导的下游过程。阿达木单抗治疗NIU包括Behcet病所致葡萄膜炎、Vogt-小柳-原田综合征、强直性脊柱炎相关葡萄膜炎、儿童葡萄膜炎等,可有效减轻炎症,减少糖皮质激素的用量,降低复发率,其安全性也已得到初步证实。阿达木单抗是NIU二线治疗适合的选择,在治疗NIU中显示出巨大的潜力。(国际眼科纵览,2022,46:336-340)     

地塞米松玻璃体内植入剂治疗黄斑水肿的研究进展

黄斑水肿是继发于多种视网膜疾病的一种常见现象,主要是由于多种因素导致毛细血管壁损害渗漏,液体和蛋白质在黄斑区视网膜内积聚,是引起视力减退的重要原因之一。临床上治疗黄斑水肿的方法主要有激光光凝、玻璃体腔注射抗血管内皮生长因子(VEGF)药物以及玻璃体腔注射糖皮质激素等。而Ozurdex作为一种新的治疗黄斑水肿的药物,可长期持续在眼内释放地塞米松,尤其对于炎性因素作用为主导的患者有巨大优势,但由于其类固醇激素成分的存在,容易引起眼压升高和白内障等不良反应。目前Ozurdex主要适用于糖尿病性黄斑水肿、视网膜静脉阻塞、玻璃体切割术后黄斑水肿、非感染性葡萄膜炎及继发于其他眼底疾病的黄斑水肿。本文根据Ozurdex目前在国内外的应用研究,对其治疗进展进行综述。     

非皮质类固醇治疗周边葡萄膜炎

非皮质类固醇治疗周边葡萄膜炎湖北宜昌市中西医结合眼科研究室秦大军睫状体平坦部及锯齿缘间的炎症称为周边葡萄膜炎。病因不明，有感染和变态反应等学说。传统治法是用皮质类固醇药物，但疗效不确。笔者采用磺胺与消炎痛联合治疗１５例，获取满意疗效。临床资料共１５例...     

人工晶状体植入术后的迟发性葡萄膜炎

目的探讨人工晶状体植入术后的迟发性葡萄膜炎的发病原因及预防方法。方法对不同类型的白内障囊外摘出联合人工晶状体植入术后所发生的迟发性葡萄膜炎11例(11眼)进行回顾性总结,分析其发病原因、发病时间、临床特点及预防方法。结果术后迟发性葡萄膜炎发生率为1.65%;自身免疫反应和术后抗生素、皮质类固醇用量不足是发病的主要原因;本病对皮质类固醇治疗敏感,只要及时治疗,一般预后良好。结论本病是由自身免疫变态反应引起的葡萄膜炎,术中尽量清理残余皮质,术后抗生素、皮质类固醇不可过早停药是降低本病的发生率的关键。     

抗肿瘤坏死因子-α及白细胞介素抑制剂治疗非感染性葡萄膜炎的研究进展

葡萄膜炎是临床上常见的一种眼内炎症性疾病,根据病因可分为感染性和非感染性葡萄膜炎（NIU）。NIU的发病机制暂不明确,目前主要认为是由T淋巴细胞驱动的自身免疫过程,其中肿瘤坏死因子-α（TNF-α）和白细胞介素（IL）,包括IL-6、IL-12、IL-17、IL-22、IL-23等,在其发病过程中起重要作用。因此,研究者们针对这些因子进行了靶向抑制药物的研发及一系列临床研究。本文对抗TNF-α制剂、IL抑制剂应用于NIU治疗的研究进展进行综述。     

地塞米松玻璃体内植入剂在非感染性葡萄膜炎继发黄斑水肿患者治疗中的作用

目的　观察地塞米松玻璃体内植入剂在治疗非感染性葡萄膜炎继发黄斑水肿中的安全性和临床疗效。方法　回顾性分析我院2019年12月至2021年12月临床确诊的非感染性葡萄膜炎继发黄斑水肿患者30例（30眼）,给予玻璃体内注射地塞米松玻璃体内植入剂治疗。所有患眼均行最佳矫正视力(BCVA)及眼压测量,并采用OCT测量黄斑中心视网膜厚度(CMT)。术后随访6个月,所有患者均于术前,术后1个月、3个月及6个月重复检测并比较BCVA、CMT。随访期间观察患者眼压变化,监测白内障进展、结膜下出血等眼部不良反应。结果　患者术前及术后1个月、3个月及6个月BCVA(logMAR)分别为0.74±0.37、0.47±0.29、0.28±0.14、0.37±0.17。患者术前,术后1个月、3个月及6个月CMT分别为(372.12± 99.42)μm、(298.14±82.44)μm、(278.45±62.43)μm、(289.31±56.34)μm。患者各时间点BCVA、CMT差异均有统计学意义（均为P<0.05)。与术前相比,患者术后1个月、3个月及6个月BCVA和CMT差异均有统计学意义（均为P<0.05）。术后各时间点两两比较结果显示,患者BCVA和CMT差异均无统计学意义（均为P>0.05)。随访期间有6例患者出现眼压升高（≥25 mmHg,1 kPa=7.5 mmHg）,经局部降眼压药物应用后降至正常水平。4例患者出现白内障进展,均无需手术治疗。结论　玻璃体内注射地塞米松玻璃体内植入剂能够提高患者视力及降低CMT,有效治疗非感染性葡萄膜炎继发黄斑水肿。     

感染性葡萄膜炎玻璃体注射疗法研究进展

非感染性葡萄膜炎（non-infectious uveitis，NIU）治疗目的是控制炎症，减少并发症，保护视力。NIU玻璃体注射疗法可减少全身副作用和药物频繁使用的问题，已成为全身用药的有效替代方案，且玻璃体注射途径的靶向治疗可实现NIU患者个性化精准治疗。玻璃体注射糖皮质激素（Ozurdex、Retisert、Iluvien、Yutiq、曲安奈德）、抗血管内皮生长因子（贝伐单抗、雷珠单抗、阿柏西普）、抗肿瘤坏死因子-α（阿达木单抗、英夫利昔单抗）、免疫抑制剂（西罗莫司、甲氨蝶呤、环孢素A）等可有效治疗NIU的炎症、黄斑水肿及炎性脉络膜新生血管的相关并发症。但由于缺乏对照研究，很难比较这些药物，且部分药物价格昂贵、临床试验经验较少。（国际眼科纵览，2021, 45： 425-430）     

New therapies in development for the management of non‐infectious uveitis: A review

Uveitis is a spectrum of inflammatory disorders characterized by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with high‐dose corticosteroids is associated with side effects and cannot be maintained long term. Therefore, steroid‐sparing agents are needed to decrease the burden of steroid therapy. Currently, the therapeutic approach for non‐infectious uveitis (NIU) consists of a step‐ladder strategy with the first‐line option being corticosteroids in various formulations followed by the use of first‐, second‐ and third‐line agents in cases with suboptimal steroid response. Unfortunately, the agents currently at our disposal have limitations such as having a narrow therapeutic window along with their own individual potential side‐effect profiles. Therefore, research has been targeted to identify newer drugs as well as new uses for older drugs that target specific pathways in the inflammatory response. Such efforts are made in order to provide targeted and safer therapy with reduced side effects and greater efficacy. Several specially designed molecular antibodies are currently in various phases of investigations that can potentially halt the inflammation in patients with NIU. In the review, we have provided a comprehensive overview of the current and upcoming therapeutic options for patients with NIU.     

Clinical review: Update on treatment of inflammatory macular edema

The aim of this review is to summarize the recent developments in the treatment of inflammatory macular edema (ME). Inflammatory ME represents a major cause of visual loss in uveitis and its adequate management is crucial for the maintenance of useful vision in patients with uveitis. Recent studies favor early treatment of inflammatory ME, even in patients with full visual acuity. After recapitulating the standard treatment modalities for inflammatory ME the authors address novel corticosteroid implants. They review the literature on the efficacy of anti-VEGF agents for inflammatory ME and point out their beneficial, but transient effects. Further, they present recent data on the value of systemic biologics in uveitic ME and evaluate the effectiveness of vitrectomy. Finally, they propose an algorithm for the treatment of inflammatory ME and point out that the individual risk-benefit ratio, especially with systemic immunosuppressive therapy, should always be considered.     

Regulatory T cells and IL-17A levels in noninfectious uveitis

Graefe's Archive for Clinical and Experimental Ophthalmology - Regulatory T cells (Tregs) have been intensively studied in a myriad of autoimmune diseases. As for noninfectious uveitis (NIU),...     

Epidemiology of Macular Edema in Uveitis

Purpose: To describe the epidemiology of macular edema (ME) in patients with uveitis.

Methods: Review of articles listed on PubMed pertaining to uveitic ME.

Results: Reported rates of uveitic ME ranging from 20% to 70%, depending on the ancillary tests used (fundus examination, fluorescein angiography, optical coherence tomography). Macular edema might develop due to uveitis itself, or occur as an adverse effect of drugs taken for different diseases. It is more frequently observed in adults than in children, in chronic uveitis, and in intermediate uveitis. Males with ankylosing spondylitis are more prone to develop ME than females. Three patterns of uveitic ME are observed, either isolated or in combination: cystoid ME, the most frequently encountered pattern seen in up to 80% of cases, diffuse ME and serous retinal detachment.

Conclusion: Older age, chronicity of uveitis and intermediate uveitis are risk factors for the development of ME in patients with uveitis.     

Association between lumican gene -1554 T/C polymorphism and high myopia in Asian population:a meta-analysis

Uveitis is one of the most important causes of blindness worldwide. Its etiology and pathogenesis are complicated and have not been well understood. The treatment for uveitis is predominantly based on steroids and immunosuppressants. However, systemic side effects limit their clinical application. With the advancement of molecular biology, some intravitreal implants and biologic agents have been used for the treatment of uveitis. Additionally, novel techniques such as gene therapy and RNA interference are being studied for using as uveitis therapy. This paper reviews recent advances in uveitis treatment.     

Role of OCT in the Diagnosis and Management of Macular Edema from Uveitis

Uveitis is a potentially visually threatening disease accounting for 10% of vision loss in the developed world. The most common cause of vision loss in patients with uveitis has been shown to be macular edema (ME). The early detection and management of ME is critical to preserve vision in these patients. Optical coherence tomography (OCT) is a valuable tool in the management of many ocular diseases. The use of OCT has revolutionized the diagnosis and management of macular edema from a wide variety of ophthalmological diseases, including uveitis. In this review, we evaluate the role of OCT in the diagnosis and management of uveitic macular edema.