Refractory Macular Edema Treated by Intravitreal Adalimumab in a Patient with Central Retinal Vein Occlusion

玻璃體內注射adalimumab治療視網膜中心靜脈阻塞之病患併發之頑固性黃斑部水腫

王嘉康(Jia-Kang Wang)

《中華民國眼科醫學會雜誌》 52卷1期 (2013/04) Pp. 53-59

https://doi.org/10.30048/ACTASOS.201304_52(1).0009

摘要

目的：本報告描述以玻璃體內注射adalimumab，治療視網膜中心靜脈阻塞之病患併發之頑固性黃斑部水腫。方法：一名69歲台灣男性，因罹患右眼視網膜中心靜脈阻塞，接受全視網膜鐳射光凝固治療，眼底光同調斷層掃描顯示，嚴重之囊狀黃斑部水腫及視網膜下積液。結果：起初玻璃體內注射癌思停1.25毫克，可減少中央黃斑部厚度，及增加視力，但黃斑部水腫於注射後3個月復發，且對玻璃體內注射癌思停、樂舒晴、類固醇當無反應，最後以玻璃體內注射adalimumab 2毫克（0.04毫升），是一種腫瘤壞死因子α之單株抗體，但於追蹤一至三個月後，視力、中央黃斑部厚度、及中央黃斑部體積皆無改變。結論：玻璃體內注射adalimumab，可能對因視網膜中心靜脈阻塞，造成之頑固性黃斑部水腫無效。

並列摘要

Purpose: To describe the clinical outcome of refractory macular edema managed by intravitreal adalimumab in one patient with central retinal vein occlusion.Methods: A 69-year-old Taiwanese man suffered from central retinal vein occlusion and underwent panretinal photocoagulation in the right eye. Spectral-domain optical coherence tomography demonstrated severe macular edema with cystoid change and subretinal fluid.Results: Initially, intravitreal bevacizumab (1.25 mg) decreased central foveal thickness and increased visual acuity. However, macular edema recurred 3 months after the bevacizumab injection and failed to respond to each of four separate subsequent treatments: intravitreal bevacizumab, intravitreal ranibizumab (0.5 mg), intravitreal triamcinolone (1 mg), and finally intravitreal adalimumab 2 mg in 0.04 mL, a monoclonal antibody to tumor necrosis factor F. Visual acuity, central foveal thickness, and central macular volume remained unchanged at each of the one-month and three-month follow-up examinations.Conclusions: Intravitreal adalimumab may not be helpful in some cases of intractable macular edema secondary to central retinal vein occlusion.

並列關鍵字

refractory macular edema ； central retinal vein occlusion ； intravitreal adalimumab