目的：观察地塞米松玻璃体内植入剂(Ozurdex)治疗难治性非感染性葡萄膜炎的有效性和安全性及其对全身糖皮质激素和免疫抑制剂使用剂量的影响。

方法：回顾性系列病例研究。纳入2018-01/2019-09确诊为难治性非感染性葡萄膜炎并采用地塞米松玻璃体内植入剂治疗的患者19例21眼，观察地塞米松玻璃体内植入剂治疗后1、2、4、6mo患者的最佳矫正视力(BCVA，LogMAR)、中央视网膜厚度(CRT)、炎性玻璃体混浊评分、全身使用糖皮质激素和免疫抑制剂剂量，并与基线进行比较。

结果：研究眼基线平均BCVA 0.671±0.469，CRT 369.667±177.100μm，眼压14.26±3.44mmHg。地塞米松玻璃体内植入剂治疗1、2、4、6mo后BCVA较基线显著改善(P<0.05)、CRT较基线降低(P<0.05)、玻璃体混浊评分显著降低(P<0.05)。随访期间，部分患者眼压较基线升高，但末次随访所有患者眼压均在正常值范围。基线时，患者6例6眼口服醋酸泼尼松治疗，平均剂量为35.8mg/d； 随访6mo时，仅2例患者需口服醋酸泼尼松(平均剂量为5mg/d)。除3例白塞病患者在4～6mo期间黄斑水肿复发外，其余患者随访至6mo均未复发。

结论：地塞米松玻璃体内植入剂治疗非感染性难治性葡萄膜炎安全有效，可显著改善视力，减轻黄斑水肿，减轻玻璃体炎症，减少系统性糖皮质激素使用剂量。

METHODS: This was a retrospective, case series study conducted between January 2018 and September 2019, the patients with noninfectious refractory uveitis and treated with intravitreal implantation of dexamethasone intravitreal implant were included. The best corrected visual acuity(BCVA), central retinal thickness(CRT), vitreous haze score, and intraocular pressure(IOP)at 1mo, 2mo, 4mo and 6mo after the implantation of dexamethasone intravitreal implant were compared with the baseline. Meanwhile, the dosage of corticosteroids and immunosuppressive agent used before and after the implantation of dexamethasone was also evaluated. The data was displayed as mean±standard deviation and analyzed using the paired t-test.

RESULTS: A total of 19 patients(21 eyes)were included in the present study. The mean baseline BCVA of the included patients was 0.671±0.469, while the mean CRT was 369.667±177.100μm, and the mean intraocular pressure(IOP)was 14.252±3.181mmHg. One month, 2mo, 4mo and 6mo after the injection of Ozrudex, BCVA was significantly improved compared with the baseline(P<0.05), while the CRT and vitreous haze score were significantly reduced(P<0.05, P<0.05). During the follow-up period, IOP of several patients significantly increased, but normal IOP can be observed at the end of the follow-up for all included patients. At baseline, 6 patients(6 eyes)were treated with systemic corticosteroids with an average dosage of 35.8mg/d, while only 2 patients were treated with systemic corticosteroids at the end of the 6mo follow-up(5mg/d). Apart from 3 eyes with Behcet's disease which showed recurrence of macular edema between 4-6mo, no other patient underwent that.

CONCLUSION: Dexamethasone intravitreal implantis considered to be a safe and effective approach for non-infectious refractory uveitis which can reduce systemic medication, with significant improvement of BCVA, reduction of CRT, vitreous haze score and the dosage of systemic corticosteroids.