醋甲唑胺治疗难治性葡萄膜炎黄斑水肿的临床观察

目的:评价醋甲唑胺辅助治疗难治性葡萄膜炎黄斑水肿(refractory uveitic macular edema,RUME)的有效性及安全性.方法:采用回顾性自身对照观察研究.收集2015-01/2016-06就诊于上海市第一人民医院眼科的口服醋甲唑胺的RUME患者15例20眼.观察基线、用药2、4、8wk后黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)的变化、并发症发生率及停药后的复发率.结果:基线、用药2、4、8wk后CMT分别为445.95±154.10、338.83±138.34、251.50±40.20、244.90±35.68μm,用药前后不同时间点CMT总体间比较,差异具有统计学意义(F=15.467,P<0.05).基线、用药2、4、8wk后BCVA(LogMAR)分别为0.40±0.17、0.28±0.21、0.19±0.20、0.18±0.21.用药前后不同时间点BCVA总体间比较,差异具有统计学意义(F=5.208,P<0.05).累计用药700、1400mg时无醋甲唑胺相关并发症出现;累计用药2800mg时,共5例(33%)患者出现醋甲唑胺相关并发症,停药1wk,1、3mo后分别有3例(20%)、5例(33%)、8例(53%)复发.结论:口服醋甲唑胺4wk即可有效改善RUME患者黄斑水肿、提高视力;累计用药超过1400mg时,需警惕并发症发生;停药1wk后即有患者水肿复发,3mo后超过一半患者水肿复发,故停药后3mo内应密切随访.

Effect of methazolamide in patients with refractory uveitic macular edema

AIM:To evaluate the efficacy and safety of methazolamide in treating refractory uveitic macular edema.METHODS: Retrospective self-controlled study was designed.A total of 15 patients (20 eyes) with refractory uveitic macular edema which used methazolamide as adjuvant therapy were enrolled in Shanghai First People`s Hospital from January 2015 to June 2016.The changes of central macular thickness (CMT) and best corrected visual acuity (BCVA) were observed at baseline and 2, 4, 8wk after treatment.We also focused on the incidence of complications and relapse.RESULTS: The CMT was 445.95±154.10μm, 338.83±138.34μm, 251.50±40.20μm, 244.90±35.68μm at baseline, 2, 4 and 8wk after treatment, respectively.The differences among them were statistically significant (F=15.467, P<0.05).The BCVA (log MAR) were 0.40±0.17, 0.28±0.21, 0.19±0.20, 0.18±0.21 at baseline, 2, 4 and 8wk respectively, with a significant difference among them (F=5.208, P<0.05).When the cumulative dose reached to 700mg and 1400mg, no one had methazolamide-related complications;and when it came to 2800mg, 5 patients (33%) had methazolamide-related complication.After the withdrawal of methazolamide 1wk, 1 and 3mo, 3 patients (20%), 5 patients (33%) and 8 patients (53%) relapsed, respectively.CONCLUSION: Methazolamide is beneficial in improving macular edema and vision in 4wk.When the cumulative dose is more than 1400mg, we need pay attention to the complications.After discontinuing methazolamide for 1wk, macular edema relapsed in some patients, and more than half of patients recurred after 3mo.So the patients should be followed closely in 3mo after withdrawal of methazolamide.