Intravitreal Therapy for Uveitic Macular Edema-Ranibizumab versus Methotrexate versus the Dexamethasone Implant

Ophthalmology Volume 130, Number 9, September 2023

對於葡萄膜炎性水腫的玻璃體內治療 – Ranibizumab 與 Methotrexate 對比 the Dexamethasone Implant

中文摘要

多中心葡萄膜炎類固醇治療試驗（Multicenter Uveitis Steroid Treatment Trial, MUST）研究小組進行了一項研究，評估了三種不同的玻璃體內治療（Dexamethasone、Methotrexate和Ranibizumab）對持續或復發的葡萄膜炎性水腫（ME）的療效。來自33個中心的患者被隨機分配接受其中一種治療。主要結果是12週內的視網膜厚度變化。研究發現，只有Dexamethasone組的最佳矯正視力（BCVA）在統計上有顯著改善，並且在12週內在減少視網膜厚度和解決ME方面優越。然而，Dexamthasone組的眼內壓升高發生率較高。Methotrexate的結果較不理想，其中心亞區厚度（central subfield thickness, CST）的減少在臨床上無意義。該研究得出結論，在12週的5追蹤中，對於具有不活躍(inactive)或輕微活躍(minimally active)葡萄膜炎的患者，Dexamethasone優於Methotrexate和Ranibizumab，用於治療持續或復發的ME。

English Abstract

The Multicenter Uveitis Steroid Treatment Trial (MUST) Research Group conducted a study to evaluate the effectiveness of three different intravitreal treatments—dexamethasone, methotrexate, and ranibizumab—for persistent or recurrent uveitic macular edema (ME). Patients from 33 centers were randomized to receive one of these treatments. The primary outcome was reduction in centrals subfield thickness (CST) expressed as a proportion of baseline (CST per CST at baseline) at 12 weeks. The study found that only the dexamethasone group showed a statistically significant improvement in Best-Corrected Visual Acuity (BCVA) and was superior in reducing retinal thickness and resolving ME at 12 weeks. However, the incidence of elevated IOP (elevations of IOP by 10mmHg,to 24mmHg or more,or both) was higher in the dexamethasone group, but IOP spikes to 30mmHg or more were uncommon overall and were not significantly different among groups. Methotrexate showed less promising results, and its reduction in Central Subfield Thickness (CST) was not clinically meaningful. The study concluded that dexamethasone was superior to methotrexate and ranibizumab for treating persistent or recurrent ME in patients with inactive or minimally active uveitis at the 12-week follow-up.