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2019 | 6 | 2 | 112-119
Article title

Czy terapia implantem doszklistkowym deksametazonu jest lepszym wyborem niż iniekcje leków anty-VEGF w leczeniu powikłań zakrzepu naczyń żylnych siatkówki?

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EN
Is intravitreal dexamethasone implant a better choice than anti-VEGF therapy to treat complications of RVO in the retina?
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PL
Abstracts
PL
Zakrzep naczyń żylnych siatkówki (RVO, retinal vein occlusion) to choroba naczyń siatkówki, której powikłania mogą prowadzić do obniżenia ostrości wzroku, a nawet ślepoty. Najczęstszą przyczyną obniżenia ostrości wzroku w przebiegu RVO jest przewlekły torbielowaty obrzęk plamki. W terapii stosuje się preparaty o udowodnionej skuteczności z grupy anty-VEGF: ranibizumab, aflibercept i off-label bewacyzumab, oraz glikokortykosteroidy: deksametazon w postaci implantu o przedłużonym uwalnianiu, fluocynolon i off-label triamcynolon, charakteryzujący się krótkim okresem półtrwania. Liczne doniesienia naukowe oraz badania kliniczne potwierdzają skuteczność preparatów anty-VEGF oraz glikokortykosteroidów w leczeniu RVO. Terapia powinna być dobrana indywidualnie dla każdego pacjenta, z uwzględnieniem chorób towarzyszących, zarówno ogólnoustrojowych, jak i miejscowych. Leki anty-VEGF i glikokortykosteroidy poprawiają morfologię siatkówki i naczyniówki oraz przywracają funkcję siatkówki poprzez poprawę jej czułości potwierdzoną w badaniu mikroperymetrycznym, co przekłada się na poprawę ostrości wzroku. Leczenie preparatami z grupy anty-VEGF związane jest z koniecznością reiniekcji w razie wystąpienia nawrotu obrzęku plamki i obniżenia ostrości wzroku, co z kolei wiąże się z możliwością wystąpienia zmniejszonej odpowiedzi na stosowany lek. W takiej sytuacji zaleca się zamianę na inny lek anty-VEGF (switch) lub na deksametazon.
EN
Retinal vein occlusion (RVO) is a retinal vein disease whose complications can lead to decreased visual acuity and even blindness. The most common cause of decreased visual acuity during RVO is a chronic cystoid macular edema. The therapy involves medications with proven efficacy from the anti-VEGF group: ranibizumab, aflibercept, off-label bevacizumab and corticosteroids: dexamethasone in the form of a prolonged-release implant, fluocinolone, and off-label triamcinolone, characterized by short half-life. Scientific reports and clinical trials confirm the efficacy of anti-VEGF drugs and corticosteroids in the treatment of RVO. Therapy should be selected individually for each patient, including accompanying diseases, both systemic and local ailments. Anti-VEGF drugs and corticosteroids improve the retinal and choroidal morphology and restore the function of the retina by improving its sensitivity; confirmed in the microperimetric examination, which translates into improved visual acuity. Anti-VEGF therapy is associated with the necessity of reinjection, especially in the case of recurrence of macular edema and decreased visual acuity, which may result in the possibility of a reduced response to the medicine being used. In this situation, it is recommended to switch to another anti-VEGF drug or to a dexamethasone treatment.
Discipline
Publisher
Journal
Year
Volume
6
Issue
2
Pages
112-119
Physical description
Contributors
  • 1. Klinika Okulistyki, Katedra Okulistyki, Wydział Lekarski w Katowicach, Śląski Uniwersytet Medyczny w Katowicach. 2. Oddział Okulistyki Dorosłych, Uniwersyteckie Centrum Kliniczne im. prof. Kornela Gibińskiego, Śląski Uniwersytet Medyczny w Katowicach
  • Oddział Okulistyki Dorosłych, Uniwersyteckie Centrum Kliniczne im. prof. Kornela Gibińskiego, Śląski Uniwersytet Medyczny w Katowicach
References
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article
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bwmeta1.element.psjd-be209903-bc3a-4237-910c-6e8e9ef4c288
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