糖皮质激素治疗葡萄膜炎性黄斑水肿
Glucocorticoid Treatment for Uveitic Macular Edema
DOI: 10.12677/acm.2026.1693119, PDF,   
作者: 黄澳雪：西安医学院眼科，陕西 西安；陈 颖*：西安市人民医院(西安市第四医院)，陕西省眼科医院眼底内科，陕西 西安
关键词: 葡萄膜炎性黄斑水肿；二氟泼尼酯；曲安奈德；地塞米松；氟轻松；Uveitic Macular Edema； Difluprednate； Triamcinolone Acetonide； Dexamethasone； Fluocinolone Acetonide
摘要: 葡萄膜炎性黄斑水肿(Uveitic Macular Edema, UME)是指由于葡萄膜炎引起的黄斑区视网膜内和/或视网膜下液体积聚，严重影响视功能。糖皮质激素通过其强大的抗炎效能是UME治疗的基石。本文回顾了局部、眼周、玻璃体内、脉络膜上腔和全身在内的多种给药途径和糖皮质激素类型及制剂治疗UME的效果和并发症，以期为临床医生提供科学参考，最终对患者实现疗效和安全的平衡。
Abstract: Uveitic Macular Edema (UME) refers to the accumulation of intraretinal or subretinal fluid in the macula region secondary to intraocular inflammation, resulting in significant visual impairment. Glucocorticoids, owing to their potent anti-inflammatory activity, remain the cornerstone of UME management. This review summarizes the therapeutic efficacy and complications of glucocorticoids in the management of UME, including various routes of administration-topical, periocular, intravitreal, suprachoroidal and systemic—as well as different glucocorticoid types and formulations. The aim is to provide scientific evidence for clinicians and ultimately achieve an optimal balance between therapeutic efficacy and safety for patient.
文章引用：黄澳雪, 陈颖. 糖皮质激素治疗葡萄膜炎性黄斑水肿[J]. 临床医学进展, 2026, 16(9): 905-912. https://doi.org/10.12677/acm.2026.1693119

参考文献

[1] Lardenoye, C.W.T.A., van Kooij, B. and Rothova, A. (2006) Impact of Macular Edema on Visual Acuity in Uveitis. Ophthalmology, 113, 1446-1449.
https://doi.org/10.1016/j.ophtha.2006.03.027
[2] Halgurd, B., Oest, V.S., Klefter, O.N., Subhi, Y., Cicinelli, M.V., Wied, J., et al. (2025) Cumulative Incidence of Macular Edema in Non‐Infectious Uveitis Indicates an Early Therapeutic Window. Acta Ophthalmologica, 103, 684-690.
https://doi.org/10.1111/aos.17497
[3] van Kooij, B., Probst, K., Fijnheer, R., Roest, M., de Loos, W. and Rothova, A. (2008) Risk Factors for Cystoid Macular Oedema in Patients with Uveitis. Eye, 22, 256-260.
https://doi.org/10.1038/sj.eye.6702595
[4] Xue, Y., Xiao, J. and Chen, Y. (2023) Frequency and Treatment Regimens of Macular Edema in 1946 Consecutive Patients with Noninfectious Uveitis at a Tertiary Ophthalmic Center in Shaanxi, China. Ophthalmology and Therapy, 12, 2609-2619.
https://doi.org/10.1007/s40123-023-00763-4
[5] Rothova, A., Suttorp-van Schulten, M.S., Frits Treffers, W. and Kijlstra, A. (1996) Causes and Frequency of Blindness in Patients with Intraocular Inflammatory Disease. British Journal of Ophthalmology, 80, 332-336.
https://doi.org/10.1136/bjo.80.4.332
[6] Tungsattayathitthan, U., Jenjanya, S., Choopong, P., Sanphan, W., Tesavibul, N. and Boonsopon, S. (2024) Prevalence, Clinical Characteristics, and Independent Predictors of Uveitic Macular Edema in an Asian Population: A Retrospective Cohort Study. BMC Ophthalmology, 24, Article No. 181.
https://doi.org/10.1186/s12886-024-03447-0
[7] Symes, R.J. and Forooghian, F. (2016) Topical Difluprednate Monotherapy for Uveitic Macular Edema. Canadian Journal of Ophthalmology, 51, 47-49.
https://doi.org/10.1016/j.jcjo.2015.10.007
[8] Feiler, D.L., Srivastava, S.K., Pichi, F., Bena, J. and Lowder, C.Y. (2017) Resolution of Noninfectious Uveitic Cystoid Macular Edema with Topical Difluprednate. Retina, 37, 844-850.
https://doi.org/10.1097/iae.0000000000001243
[9] Schallhorn, J.M., Niemeyer, K.M., Browne, E.N., Chhetri, P. and Acharya, N.R. (2018) Difluprednate for the Treatment of Uveitic Cystoid Macular Edema. American Journal of Ophthalmology, 191, 14-22.
https://doi.org/10.1016/j.ajo.2018.03.027
[10] Venkatesh, P., Abhas, Z., Garg, S. and Vohra, R. (2007) Prospective Optical Coherence Tomographic Evaluation of the Efficacy of Oral and Posterior Subtenon Corticosteroids in Patients with Intermediate Uveitis. Graefe’s Archive for Clinical and Experimental Ophthalmology, 245, 59-67.
https://doi.org/10.1007/s00417-006-0378-3
[11] Vegas-Revenga, N., Martín-Varillas, J.L., Calvo-Río, V., González-Mazón, I., Sánchez-Bilbao, L., Beltrán, E., et al. (2022) Intravenous Methylprednisolone Induces Rapid Improvement in Non-Infectious Uveitis: A Multicentre Study of 112 Patients. Clinical and Experimental Rheumatology, 40, 142-149.
https://doi.org/10.55563/clinexprheumatol/imrgo2
[12] Huscher, D., Thiele, K., Gromnica-Ihle, E., Hein, G., Demary, W., Dreher, R., et al. (2009) Dose-Related Patterns of Glucocorticoid-Induced Side Effects. Annals of the Rheumatic Diseases, 68, 1119-1124.
https://doi.org/10.1136/ard.2008.092163
[13] Tomkins-Netzer, O., Lightman, S., Drye, L., Kempen, J., Holland, G.N., Rao, N.A., et al. (2015) Outcome of Treatment of Uveitic Macular Edema. Ophthalmology, 122, 2351-2359.
https://doi.org/10.1016/j.ophtha.2015.07.036
[14] Kempen, J.H., Altaweel, M.M., Holbrook, J.T., Jabs, D.A., Louis, T.A., Sugar, E.A., et al. (2011) Randomized Comparison of Systemic Anti-Inflammatory Therapy versus Fluocinolone Acetonide Implant for Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment Trial. Ophthalmology, 118, 1916-1926.
https://doi.org/10.1016/j.ophtha.2011.07.027
[15] Tomkins-Netzer, O., Lightman, S.L., Burke, A.E., Sugar, E.A., Lim, L.L., Jaffe, G.J., et al. (2021) Seven-Year Outcomes of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial and Follow-Up Study Results. Ophthalmology, 128, 719-728.
https://doi.org/10.1016/j.ophtha.2020.08.035
[16] McKay, K.M., Borkar, D.S., Sevgi, D.D., Susarla, G., Papaliodis, G.N. and Sobrin, L. (2020) Comparison of Modified Posterior Sub-Tenon’s vs. Trans-Septal Triamcinolone Injection for Non-Infectious Uveitis. Ocular Immunology and Inflammation, 29, 857-864.
https://doi.org/10.1080/09273948.2019.1698748
[17] Venkatesh, P., Kumar, C.S., Abbas, Z. and Garg, S. (2009) Comparison of the Efficacy and Safety of Different Methods of Posterior Subtenon Injection. Ocular Immunology and Inflammation, 16, 217-223.
https://doi.org/10.1080/09273940802209153
[18] Liu, X., Li, Y., Zhang, Y., Du, W., Sun, S., Lin, B., et al. (2012) Comparison of Intraocular Pressure Elevation after Anterior versus Posterior Subtenon Triamcinolone Acetonide Acetate Injection. Retina, 32, 1838-1843.
https://doi.org/10.1097/iae.0b013e31824fd384
[19] Shen, L., You, Y., Sun, S., Chen, Y., Qu, J. and Cheng, L. (2010) Intraocular and Systemic Pharmacokinetics of Triamcinolone Acetonide after a Single 40-mg Posterior Subtenon Application. Ophthalmology, 117, 2365-2371.
https://doi.org/10.1016/j.ophtha.2010.03.033
[20] Leder, H.A., Jabs, D.A., Galor, A., Dunn, J.P. and Thorne, J.E. (2011) Periocular Triamcinolone Acetonide Injections for Cystoid Macular Edema Complicating Noninfectious Uveitis. American Journal of Ophthalmology, 152, 441-448.e2.
https://doi.org/10.1016/j.ajo.2011.02.009
[21] Salek, S.S., Leder, H.A., Butler, N.J., Gan, T.J., Dunn, J.P. and Thorne, J.E. (2013) Periocular Triamcinolone Acetonide Injections for Control of Intraocular Inflammation Associated with Uveitis. Ocular Immunology and Inflammation, 21, 257-263.
https://doi.org/10.3109/09273948.2013.767353
[22] Sen, H.N., Vitale, S., Gangaputra, S.S., Nussenblatt, R.B., Liesegang, T.L., Levy-Clarke, G.A., et al. (2014) Periocular Corticosteroid Injections in Uveitis: Effects and Complications. Ophthalmology, 121, 2275-2286.
https://doi.org/10.1016/j.ophtha.2014.05.021
[23] Androudi, S., Letko, E., Meniconi, M., Papadaki, T., Ahmed, M. and Foster, C.S. (2005) Safety and Efficacy of Intravitreal Triamcinolone Acetonide for Uveitic Macular Edema. Ocular Immunology and Inflammation, 13, 205-212.
https://doi.org/10.1080/09273940590933511
[24] Karacorlu, M., Mudun, B., Ozdemir, H., Karacorlu, S.A. and Burumcek, E. (2004) Intravitreal Triamcinolone Acetonide for the Treatment of Cystoid Macular Edema Secondary to Behçet Disease. American Journal of Ophthalmology, 138, 289-291.
https://doi.org/10.1016/j.ajo.2004.02.053
[25] Beer, P.M., Bakri, S.J., Singh, R.J., Liu, W., Peters, G.B. and Miller, M. (2003) Intraocular Concentration and Pharmacokinetics of Triamcinolone Acetonide after a Single Intravitreal Injection. Ophthalmology, 110, 681-686.
https://doi.org/10.1016/s0161-6420(02)01969-3
[26] Sallam, A., Taylor, S.R.J., Habot‐Wilner, Z., Elgohary, M., Do, H.H., McCluskey, P., et al. (2011) Repeat Intravitreal Triamcinolone Acetonide Injections in Uveitic Macular Oedema. Acta Ophthalmologica, 90, e323-e325.
https://doi.org/10.1111/j.1755-3768.2011.02247.x
[27] Özkiris, A. (2006) Intravitreal Triamcinolone Acetonide Injection for the Treatment of Posterior Uveitis. Ocular Immunology and Inflammation, 14, 233-238.
https://doi.org/10.1080/09273940600826604
[28] Chang-Lin, J., Attar, M., Acheampong, A.A., Robinson, M.R., Whitcup, S.M., Kuppermann, B.D., et al. (2011) Pharmacokinetics and Pharmacodynamics of a Sustained-Release Dexamethasone Intravitreal Implant. Investigative Opthalmology & Visual Science, 52, 80-86.
https://doi.org/10.1167/iovs.10-5285
[29] Chang-Lin, J., Burke, J.A., Peng, Q., Lin, T., Orilla, W.C., Ghosn, C.R., et al. (2011) Pharmacokinetics of a Sustained-Release Dexamethasone Intravitreal Implant in Vitrectomized and Nonvitrectomized Eyes. Investigative Opthalmology & Visual Science, 52, 4605-4609.
https://doi.org/10.1167/iovs.10-6387
[30] Lowder, C., Belfort Jr., R, Lightman, S., et al. (2011) Dexamethasone Intravitreal Implant for Noninfectious Intermediate or Posterior Uveitis. Archives of Ophthalmology, 129, 545-553.
https://doi.org/10.1001/archophthalmol.2010.339
[31] Cao, J.H., Mulvahill, M., Zhang, L., Joondeph, B.C. and Dacey, M.S. (2014) Dexamethasone Intravitreal Implant in the Treatment of Persistent Uveitic Macular Edema in the Absence of Active Inflammation. Ophthalmology, 121, 1871-1876.
https://doi.org/10.1016/j.ophtha.2014.04.012
[32] Ratra, D., Barh, A., Banerjee, M., Ratra, V. and Biswas, J. (2018) Safety and Efficacy of Intravitreal Dexamethasone Implant for Refractory Uveitic Macular Edema in Adults and Children. Ocular Immunology and Inflammation, 26, 1034-1040.
https://doi.org/10.1080/09273948.2018.1424342
[33] Thorne, J.E., Sugar, E.A., Holbrook, J.T., Burke, A.E., Altaweel, M.M., Vitale, A.T., et al. (2019) Periocular Triamcinolone vs. Intravitreal Triamcinolone vs. Intravitreal Dexamethasone Implant for the Treatment of Uveitic Macular Edema. Ophthalmology, 126, 283-295.
https://doi.org/10.1016/j.ophtha.2018.08.021
[34] Callanan, D.G., Jaffe, G.J., Martin, D.F., et al. (2008) Treatment of Posterior Uveitis with a Fluocinolone Acetonide Implant: Three-Year Clinical Trial Results. JAMA Ophthalmology, 126, 1191-1201.
https://doi.org/10.1001/archopht.126.9.1191
[35] Kempen, J.H., Altaweel, M.M., Holbrook, J.T., Sugar, E.A., Thorne, J.E. and Jabs, D.A. (2017) Association between Long-Lasting Intravitreous Fluocinolone Acetonide Implant vs Systemic Anti-Inflammatory Therapy and Visual Acuity at 7 Years among Patients with Intermediate, Posterior, or Panuveitis. JAMA, 317, 1993-2005.
https://doi.org/10.1001/jama.2017.5103
[36] Jaffe, G.J. and Pavesio, C.E. (2020) Effect of a Fluocinolone Acetonide Insert on Recurrence Rates in Noninfectious Intermediate, Posterior, or Panuveitis. Ophthalmology, 127, 1395-1404.
https://doi.org/10.1016/j.ophtha.2020.04.001
[37] Jabbour, M., Kodjikian, L., Bourdin, A., Rougier, M., Serrar, Y., Weber, M., et al. (2024) Efficacity and Safety of the Fluocinolone Acetonide Implant in Uveitic Macular Edema: A Real-Life Study from the French Uveitis Network. Journal of Personalized Medicine, 14, Article 245.
https://doi.org/10.3390/jpm14030245
[38] Kriegel, M., Heiligenhaus, A. and Heinz, C. (2023) Comparing the Efficacy of Intravitreal Dexamethasone and Time-Displaced Fluocinolone Acetonide on Central Retinal Thickness in Patients with Uveitis. Ocular Immunology and Inflammation, 31, 168-174.
https://doi.org/10.1080/09273948.2021.2018469
[39] Yeh, S., Khurana, R.N., Shah, M., Henry, C.R., Wang, R.C., Kissner, J.M., et al. (2020) Efficacy and Safety of Suprachoroidal CLS-TA for Macular Edema Secondary to Noninfectious Uveitis: Phase 3 Randomized Trial. Ophthalmology, 127, 948-955.
https://doi.org/10.1016/j.ophtha.2020.01.006
[40] Khurana, R.N., Merrill, P., Yeh, S., et al. (2022) Extension Study of the Safety and Efficacy of CLS-TA for Treatment of Macular Oedema Associated with Non-Infectious Uveitis (MAGNOLIA). British Journal of Ophthalmology, 106, 1139-1144.
[41] Eiger-Moscovich, M., Tomkins-Netzer, O., Amer, R., Habot-Wilner, Z., Kasb, A., Friling, R., et al. (2019) Visual and Clinical Outcome of Macular Edema Complicating Pediatric Noninfectious Uveitis. American Journal of Ophthalmology, 202, 72-78.
https://doi.org/10.1016/j.ajo.2019.02.011
[42] Guyatt, G.H., Oxman, A.D., Vist, G.E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., et al. (2008) GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations. BMJ, 336, 924-926.
https://doi.org/10.1136/bmj.39489.470347.ad

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