曾接受玻璃體視網膜手術的眼睛, 對於後續眼內藥物注射的治療反應如何? 答案是會發生改

新杉伶

曾接受玻璃體視網膜手術的眼睛, 對於後續眼內藥物注射的治療反應如何? 答案是會發生改變！

執筆 林口長庚 眼科部 葡萄膜炎/虹彩炎 學科 主任 黃奕修

根據新的研究報告, 曾接受眼玻璃體視網膜手術的病患, 注射入眼的藥物, 持續的時間都會減短.
因此, 如果是為了達到同樣的藥效, 必須更頻繁地注射, 才能達到效果.

而且, 如果是固體性質的藥物, 更會因為玻璃體膠質被移除了, 眼內藥物因此會不固定位置而四處跑動.
因此, 研究顯示, 病人眼內出血的機率更因此上昇了超過十倍.


長庚醫院 林口醫學中心 眼科部 葡萄膜炎/虹彩炎/視網膜科 黃奕修 主任 執筆

醫學新知/最夯科技/訊息導正/連續照護/防盲責任

更多眼科資訊, 請見:
www.uveitis.tw        葡萄膜炎虹彩炎資訊網
www.dmeye.org[/url]        糖尿病眼病變資訊網
www.dreye.net        醫師的眼科醫師-眼科高端醫療資訊網
www.retina.tw        黃奕修醫師-視網膜病變資訊網

原文如下:
Are intravitreal injections safe and effective in previously vitrectomized eyes? It may depend on the type of drug, according to Damien C. Rodger, MD, PhD, during the Retina Subspecialty Day on Friday.

More frequent injections with triamcinolone? In a literature review, Dr. Rodger noted that studies conducted with rabbit eyes do not support changing frequency or dosage in vitrectomized versus nonvitrectomized eyes for ranibizumab or dexamethasone. However, studies on triamcinolone acetonide show that the vitreous half-life was less than that in controls (1.6 vs. 2.9 days), and the steroid was detected in only 1 of 42 eyes in the vitrectomized group versus 4 of 6 control eyes at 1 month postinjection. Thus, these data suggest that more frequent injections of triamcinolone acetonide may be necessary in vitrectomized eyes.

Vitreous status influences implant localization. Additionally, Dr. Rodger's retrospective study on dexamethasone implants showed that implants may behave differently in vitrectomized eyes. The implant was found to localize to the retinal surface, settling inferiorly in 100% of the vitrectomized eyes compared with 6.8% of the native eyes. Of concern, more vitrectomized eyes also experienced a vitreous hemorrhage (20% vs. 1.5%, respectively).

Possibility of a retinal strike. Finally, Dr. Rodger discussed his prospective ex vivo study in enucleated porcine eyes. This showed that a dummy dexamethasone implant injected 4 mm inferotemporally to the limbus struck the retina in 11 of 12 vitrectomized eyes, compared with just 1 of 12 control eyes. To reduce the possibility of a retinal strike, Dr. Rodger suggests aiming away from macula or optic nerve in vitrectomized eyes.—Keng Jin Lee

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