Пути повышения эффективности купирования макулярного отека у пациентов с синдромными увеитами

Abstract

Purpose. To develop technology for topical corticosteroid (CS) therapy for uveitis complicated by macular edema (ME), including sub-Tenon's infusion of CS in combination with intravitreal injection the Ozurdex® implant (Allergan Pharmaceuticals Ireland). Material and methods. 37 patients with chronic recurrent uveitis complicated by ME. Based on results of examination, dependence of uveitis on systemic diseases (ankylosing spondylitis, rheumatoid arthritis, etc.) was established. Patients were divided into 2 groups depending on treatment after completion of sub-Tenon's infusion of dexamethasone: 1st – 20 patients with intravitreal Ozurdex implant; 2nd – 17 patients who continued only dexamethasone instillations. Ophthalmological examination of patients, in addition to standard methods, included optical coherence tomography of the macular area and microperimetry. The criterion of clinical effectiveness of treatment was dynamics of functional (best corrected visual acuity – BCVA, light sensitivity) and morphological (central foveal thickness) indicators of the macular area. All studies were carried out before treatment, 10 days, 1, 3, 6 and 12 months after the end of CS therapy. Results. The main intergroup differences were diagnosed 1 month after start of treatment. In patients of the 1st group, the clinical symptoms of uveal inflammation disappeared; the largest increase in functional parameters compared to baseline was recorded: BCVA – by 0.59. In patients of the 2nd group, some clinical symptoms of uveal inflammation still persisted. Only 3 months after start of treatment in patients of the 2nd group, the optimal functional and morphological result was obtained, which turned out to be lower than in the 1st group, and did not show stable stability at longer followup periods (6–12 months). Conclusion. The developed optimized method of CS therapy for uveitis complicated by ME showed high clinical efficiency: a 3-fold reduction in duration of relief of clinical symptoms of uveal inflammation, a 1.25-fold increase in frequency of complete resorption of ME with restoration of normal cellular topography of retina in macula, an increase in 2.2 times of BCVA and in 2.35 times light sensitivity. Keywords: uveitis, macular edema, corticosteroid therapy, dexamethasone, Ozurdex®