Офтальмохирургия. 2022; : 49-53
Влияние диабетической ретинопатии на внутриглазное давление при терапии кортикостероидами
https://doi.org/10.25276/0235-4160-2022-1-49-53Аннотация
Цель. Оценка влияния сахарного диабета (СД) различного типа, диабетической ретинопатии, кратности интравитреальных иньекций (ИВИ) препарата Озурдекс® на офтальмогипертензию и ее коррекцию.
Материал и методы. Выполнено 179 ИВИ препарата Озурдекс® 148 пациентам (66 мужчин, 82 женщины) в возрасте 53,5 (39/69) года. Однократное введение проведено 123 пациентам (123 глаза), два введения и более – 25 пациентам (25 глаз). Пациенты были разделены по типам диабета и стадиям ретинопатии: непролиферативная диабетическая ретинопатия (19,5% пациентов), препролиферативная диабетическая ретинопатия (44%), пролиферативная диабетическая ретинопатия (36,5%). Уровень внутриглазного давления (ВГД) исследовали до ИВИ, на следующий день и через 1 месяц после введения препарата. В случаях выявления офтальмогипертензии применяли местные ингибиторы карбоангидразы как моно, так и в комбинации с β-адреноблокаторами по стандартной схеме.
Результаты. Офтальмогипертензия выявлена у 33% пациентов (после первой иньекции в 91% случаев, после второй иньекции в 9%) и была стабилизирована медикаментозно. Пациентам с ранее проведенной лазерной коагуляцией сетчатки не потребовалась комбинированная медикаментозная терапия. Средние значения офтальмотонуса у всех пациентов имели тенденцию к снижению (p<0,01). Катаракта была диагностирована в 57% случаев, факоэмульсификация катаракты после первой ИВИ проведена в 7%, после второй иньекции – в 15% случаев. Коэффициент корреляции (r) между уровем ВГД до и после лечения составил –0,0221. Статистической взаимосвязи между развитием офтальмогипертензии и количеством полученных инъекций препарата Озурдекс® выявлено не было.
Заключение. Подъем ВГД после введения интравитреально имплантата Озурдекс® на 10% диагностировался чаще у пациентов с СД 1-го типа и в 54% случаев приходился на долю препролиферативной диабетической ретинопатии. Офтальмогипертензия поддавалась медикаментозной коррекции в течение 3–11 месяцев и у 1/2 больных компенсировалась самостоятельно. Кореляции между гипертензией и количеством иньекций препарата Озурдекс® не было выявлено.
Список литературы
1. Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017;237(4): 185–222. doi: 10.1159/000458539
2. Gupta N, Mansoor S, Sharma A, et al. Diabetic retinopathy and VEGF. Open Ophthalmol J. 2013;7: 4–10. doi: 10.2174/1874364101307010004
3. Mi-crovascular and Acute complications in IDDM patients: the EURODIAB IDDM complications study. Diabetologia. 1994;37: 278–285. doi: 10.1007/bf00398055
4. Audren F, Lecleire-Collet A, Erginay A, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4 mg vs 2 mg. Am J Ophthalmol. 2006;142(5): 794–799.
5. Lambiase A, Abdolrahimzadeh S, Recupero SM. An update on intravitreal implants in use for eye disorders. Drugs Today. 2014;50(3): 239–249.
6. Malclès A, Dot C, Voirin N, et al. Real-life study in diabetic macular edema treated with dexamethasone implant: the reldex study. Retina. 2017;37(4): 753–760.
7. Güler E, Totan Y and Betül Güragaç F. Intravitreal bevacizumab and dexamethasone implant for treatment of chronic diabetic macular edema. Cutan Ocul Toxicol. 2017;36(2): 180–184.
8. Pareja-Rios A, Ruiz-de la Fuente-Rodriguez P, Bonaque- Gonzalez S, et al. Intravitreal dexamethasone implants for diabetic macular edema. Int J Ophthalmol. 2018;11(1): 77–82.
9. Bellocq D, Akesbi J, Matonti F, et al. The pattern of recurrence in diabetic macular edema treated by dexamethasone implant: the PREDIAMEX study. Ophthalmol Retina. 2018;2: 567–573.
10. Malclès A, Dot C, Voirin N, et al. Safety of intravitreal dexamethasone implant (OZURDEX): the SAFODEX study. Incidence and risk factors of ocular hypertension. Retina. 2017;37: 1352–1359.
11. Callanan DG, Gupta S, Boyer DS, Ciulla TA, Singer MA, Kuppermann BD, Liu CC, Li XY, Hollander DA, Schiffman RM, Whitcup SM. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology. 2013;120: 1843–1851.
12. Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, Li XY, Cui H, Hashad Y, Whitcup SM. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121: 1904–1914.
13. Malclès A, Dot C, Voirin N, et al. Safety of intravitreal dexamethasone implant (OZURDEX): the SAFODEX study. Incidence and risk factors of ocular hypertension. Retina. 2017;37: 1352–1359.
14. Coscas G, Augustin A, Bandello F. Retreatment with Ozurdex for macular edema secondary to retinal vein occlusion. Eur J Ophthalmol. 2014;24(1): 1–9. doi: 10.5301/ejo.5000376
Fyodorov Journal of Ophthalmic Surgery. 2022; : 49-53
Diabetic retinopathy impact on intraocular pressure during corticosteroid therapy
https://doi.org/10.25276/0235-4160-2022-1-49-53Abstract
Purpose. Evaluation the impact of various types of diabetes mellitus, diabetic retinopathy and frequency of IVI injections of Ozurdex® on ophthalmic hypertension and its correction.
Material and methods. 179 intravitreal injections of Ozurdex® in 148 patients (men – 66, women – 82) at the age of 53.5 (39/69) years have been performed. 123 patients (123 eyes) have undergone one surgery, 25 patients (25 eyes) have undergone two or more surgeries. The patients have been divided according to the types of diabetes and stages of retinopathy: non-proliferative diabetic retinopathy 19.5%, preproliferative diabetic retinopathy 44%, proliferative diabetic retinopathy 36.5% of patients, respectively. IOP level has been investigated before IVI, the next day, and 1 month after injection. In cases of ocular hypertension, local carbonic anhydrase inhibitors were used both mono and in combination with betaadrenoblockers according to the standard scheme.
Results. Ophthalmic hypertension has been detected in 33% of patients, after the first injection in 91% of cases, and after the second injection in 9% of cases, and has been stabilized with medication. Patients who have undergone laser photocoagulation did not require combined drug therapy. The mean values of the ophthalmotonus of all patients tended to decrease (p<0.01). Cataract has been diagnosed in 57% of cases, phacoemulsification after the first IVI has been performed in 7%, and in 15% of cases after the second injection. The correlation coefficient between the IOP level before and after treatment was r = –0.0221. There was no statistical relationship between the development of ophthalmic hypertension and the number of Ozurdex® injections received.
Conclusion. The rise in intraocular pressure, after the intravitreal injection of the Ozurdex® implant, is diagnosed 10% more often in patients with type I diabetes and in 54% of cases it was the share of preproliferative diabetic retinopathy. Ophthalmic hypertension was amenable to drug therapry within 3–11 months and compensated independently in half of patients. No correlation between hypertension and the number of Ozurdex® injections was found.
References
1. Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017;237(4): 185–222. doi: 10.1159/000458539
2. Gupta N, Mansoor S, Sharma A, et al. Diabetic retinopathy and VEGF. Open Ophthalmol J. 2013;7: 4–10. doi: 10.2174/1874364101307010004
3. Mi-crovascular and Acute complications in IDDM patients: the EURODIAB IDDM complications study. Diabetologia. 1994;37: 278–285. doi: 10.1007/bf00398055
4. Audren F, Lecleire-Collet A, Erginay A, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4 mg vs 2 mg. Am J Ophthalmol. 2006;142(5): 794–799.
5. Lambiase A, Abdolrahimzadeh S, Recupero SM. An update on intravitreal implants in use for eye disorders. Drugs Today. 2014;50(3): 239–249.
6. Malclès A, Dot C, Voirin N, et al. Real-life study in diabetic macular edema treated with dexamethasone implant: the reldex study. Retina. 2017;37(4): 753–760.
7. Güler E, Totan Y and Betül Güragaç F. Intravitreal bevacizumab and dexamethasone implant for treatment of chronic diabetic macular edema. Cutan Ocul Toxicol. 2017;36(2): 180–184.
8. Pareja-Rios A, Ruiz-de la Fuente-Rodriguez P, Bonaque- Gonzalez S, et al. Intravitreal dexamethasone implants for diabetic macular edema. Int J Ophthalmol. 2018;11(1): 77–82.
9. Bellocq D, Akesbi J, Matonti F, et al. The pattern of recurrence in diabetic macular edema treated by dexamethasone implant: the PREDIAMEX study. Ophthalmol Retina. 2018;2: 567–573.
10. Malclès A, Dot C, Voirin N, et al. Safety of intravitreal dexamethasone implant (OZURDEX): the SAFODEX study. Incidence and risk factors of ocular hypertension. Retina. 2017;37: 1352–1359.
11. Callanan DG, Gupta S, Boyer DS, Ciulla TA, Singer MA, Kuppermann BD, Liu CC, Li XY, Hollander DA, Schiffman RM, Whitcup SM. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology. 2013;120: 1843–1851.
12. Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, Li XY, Cui H, Hashad Y, Whitcup SM. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121: 1904–1914.
13. Malclès A, Dot C, Voirin N, et al. Safety of intravitreal dexamethasone implant (OZURDEX): the SAFODEX study. Incidence and risk factors of ocular hypertension. Retina. 2017;37: 1352–1359.
14. Coscas G, Augustin A, Bandello F. Retreatment with Ozurdex for macular edema secondary to retinal vein occlusion. Eur J Ophthalmol. 2014;24(1): 1–9. doi: 10.5301/ejo.5000376
