Tratamento do edema macular secundário à uveíte utilizando duas doses de acetato de triancinolona: estudo comparativo
Data
2024-10-02
Autores
Souza, Carlos Eduardo de 
Orientadores
Muccioli, Cristina
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Comparar a resposta terapêutica do acetato de triancinolona intravítreo nas doses de 2mg (0,05ml) e 4mg (0,1ml) nos pacientes com edema macular secundário à uveíte não-infecciosa. Método: Estudo prospectivo experimental randomizado e duplo-cego realizado no Departamento de Oftalmologia e Ciências Visuais da Escola Paulista de Medicina (Universidade Federal de São Paulo). Os pacientes foram divididos em dois grupos (randomização 1:1): O grupo A recebeu a dose de 4 mg (0,1 ml) e o grupo B a dose de 2 mg (0,05 ml). No exame inicial, os pacientes foram submetidos à avaliação oftalmológica com exame de acuidade visual, biomicroscopia, fundoscopia e tonometria, tomografia de coerência óptica, angiofluoresceinografia e foram ainda solicitados a responder ao questionário de avaliação da qualidade de vida (VFQ-NEI). Todos os sujeitos do estudo foram avaliados 7, 30, 60 e 90 dias após o procedimento e nessas consultas subsequentes, apenas a angiofluoresceinografia não era repetida. No último dia de seguimento (90 dias), os pacientes foram solicitados a responder novamente ao questionário de qualidade de vida. O procedimento foi realizado pelo mesmo cirurgião, no centro cirúrgico do referido departamento, utilizando técnica estéril, seringa de 1 ml com agulha 13 mm x 0,3 mm, e a aplicação era realizada entre 3,5 mm e 4,0 mm do limbo, preferencialmente no quadrante temporal inferior. As análises estatísticas foram conduzidas utilizando a linguagem R, open source, em sua versão 4.3.0. Um resultado foi considerado estatisticamente significante no nível de significância p < 0,05. Resultados: Foram incluídos 16 pacientes em cada grupo, estatisticamente homogêneos no exame inicial em relação à idade, ao sexo, à espessura central da retina, à acuidade visual e à pressão intraocular. Houve uma diferença estatisticamente significante (p = 0,026) a favor do grupo de maior dose (grupo A) em relação à redução da espessura central da retina ao final do seguimento. Em relação à avaliação funcional (acuidade visual) e aumento da pressão intraocular, houve equivalência entre os grupos (p = 0,192 e 0,143 respectivamente). As respostas do questionário de qualidade de vida apontaram melhores resultados na escala de visão de perto e saúde mental no grupo de maior dose. Os exames de imagem mostraram o fluido sub-retiniano como possível valor indicativo de melhor prognóstico e vasculite retiniana como possíveis indicador de pior prognóstico. Conclusão: O uso do acetato de triancinolona intravítreo na dose de 4 x mg para o tratamento do edema macular secundário à uveíte não-infecciosa pode resultar em melhor resultado anatômico, menor taxa de recidiva, e indicadores mais favoráveis quanto à qualidade de vida.
Objective: To compare the therapeutic response of intravitreal triamcinolone acetonide at doses of 2mg (0.05 ml) and 4mg (0.1ml) in patients with macular edema secondary to non-infectious uveitis. Method: Prospective, randomized, double-blind study carried out at the Department of Ophthalmology and Visual Sciences of the Escola Paulista de Medicina (Federal University of São Paulo). Patients were divided into two groups (1:1 randomization): group A received a dose of 4 mg (0.1 ml) and group B a dose of 2 mg (0.05 ml). At the initial examination, patients underwent complete ophthalmological evaluation (visual acuity, biomicroscopy, fundoscopy and intraocular pressure), optical coherence tomography, fluorescein angiography and were also asked to respond to the quality-of-life assessment questionnaire (VFQ-NEI). All study subjects were evaluated 7, 30, 60 and 90 days after the procedure and in these subsequent consultations, only the fluorescein angiography was not repeated. On the last day of follow-up (90 days), patients were asked to answer the quality-of-life questionnaire again. The procedure was performed by the same surgeon, in the surgical center of that department, using sterile technique, 1 ml syringe with a 13 mm x 0.3 mm needle, and the application was carried out between 3.5 mm and 4.0 mm from the limbus, preferably in the inferior temporal quadrant. Statistical analyzes were conducted using the open-source R language, version 4.3.0. A result was considered statistically significant at the P < 0.05 significance level. Results: 16 patients were included in each group, statistically homogeneous at the initial examination in relation to age, sex, central retinal thickness, visual acuity and intraocular pressure. There was a statistically significant difference (p = 0,026) in favor of the highest dose group (group A) in relation to the reduction in central retinal thickness at the end of follow-up. Regarding functional assessment (visual acuity) and increased intraocular pressure, there was equivalence between the groups (p = 0.192 and 0.143 respectively). The answers to the quality-of-life questionnaire pointed to better results on near vision and mental health scale in the highest dose group. Imaging exams showed subretinal fluid as a possible predictive value for a better prognosis and retinal vasculitis as possible predictors of a worse prognosis. Conclusion: The use of intravitreal triamcinolone acetonide at a dose of 4 mg for the treatment of macular edema secondary to non-infectious uveitis can result in better anatomical results, a lower recurrence rate, and more favorable indicators regarding quality of life.
Objective: To compare the therapeutic response of intravitreal triamcinolone acetonide at doses of 2mg (0.05 ml) and 4mg (0.1ml) in patients with macular edema secondary to non-infectious uveitis. Method: Prospective, randomized, double-blind study carried out at the Department of Ophthalmology and Visual Sciences of the Escola Paulista de Medicina (Federal University of São Paulo). Patients were divided into two groups (1:1 randomization): group A received a dose of 4 mg (0.1 ml) and group B a dose of 2 mg (0.05 ml). At the initial examination, patients underwent complete ophthalmological evaluation (visual acuity, biomicroscopy, fundoscopy and intraocular pressure), optical coherence tomography, fluorescein angiography and were also asked to respond to the quality-of-life assessment questionnaire (VFQ-NEI). All study subjects were evaluated 7, 30, 60 and 90 days after the procedure and in these subsequent consultations, only the fluorescein angiography was not repeated. On the last day of follow-up (90 days), patients were asked to answer the quality-of-life questionnaire again. The procedure was performed by the same surgeon, in the surgical center of that department, using sterile technique, 1 ml syringe with a 13 mm x 0.3 mm needle, and the application was carried out between 3.5 mm and 4.0 mm from the limbus, preferably in the inferior temporal quadrant. Statistical analyzes were conducted using the open-source R language, version 4.3.0. A result was considered statistically significant at the P < 0.05 significance level. Results: 16 patients were included in each group, statistically homogeneous at the initial examination in relation to age, sex, central retinal thickness, visual acuity and intraocular pressure. There was a statistically significant difference (p = 0,026) in favor of the highest dose group (group A) in relation to the reduction in central retinal thickness at the end of follow-up. Regarding functional assessment (visual acuity) and increased intraocular pressure, there was equivalence between the groups (p = 0.192 and 0.143 respectively). The answers to the quality-of-life questionnaire pointed to better results on near vision and mental health scale in the highest dose group. Imaging exams showed subretinal fluid as a possible predictive value for a better prognosis and retinal vasculitis as possible predictors of a worse prognosis. Conclusion: The use of intravitreal triamcinolone acetonide at a dose of 4 mg for the treatment of macular edema secondary to non-infectious uveitis can result in better anatomical results, a lower recurrence rate, and more favorable indicators regarding quality of life.
Descrição
Citação
SOUZA, Carlos Eduardo de. Tratamento do edema macular secundário à uveíte utilizando duas doses de acetato de triancinolona: estudo comparativo. 2024. 127 f. Tese (Doutorado em Oftalmologia e Ciências Visuais) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.