METHODS: This retrospective study included 41 patients with advanced IERM who underwent vitrectomy and were divided into a pars plana vitrectomy (PPV) group (20 eyes) and a dexamethasone (DEX) group (21 eyes) based on intravitreal DEX implantation. We collected data on best-corrected visual acuity (BCVA), central macular thickness (CMT), disorganization of the retinal inner layers (DRIL), subretinal fluid, intraretinal cystoid changes (IRC), integrity of the inner-outer segment layer, and intraocular pressure.
RESULTS: BCVA improved significantly in both groups; the DEX group had a higher visual acuity gain at 1 and 6 months (P = 0.002 and 0.023, respectively). Postoperative CMT gradually decreased in both groups, with the DEX group showing a greater decrease at 1 and 6 months (P = 0.009 and 0.033, respectively). Six months after surgery, the DRIL and IRC grades in the DEX group were significantly improved compared to those in the PPV group (P = 0.037 and 0.038, respectively). Multivariate regression analyses revealed that patients with intraoperative DEX implants were more likely to have a significant CMT reduction (≥ 100 μm) from baseline (odds ratio (OR), 9.44; 95% confidence intervals (CI), 1.58-56.56; P = 0.014) at 6 months and less likely to exhibit DRIL at 6 months postoperatively (OR, 0.08; 95% CI, 0.01-0.68; P = 0.021).
CONCLUSIONS: Vitrectomy combined with intravitreal DEX implantation facilitates the recovery of postoperative visual acuity and improvement of anatomical outcomes in patients with advanced IERM, effectively reducing CMT and improving DRIL.
方法:这项回顾性研究纳入了41例接受玻璃体切除术的晚期IERM患者,并根据玻璃体内DEX植入分为平坦部玻璃体切除术(PPV)组(20只眼)和地塞米松(DEX)组(21只眼)。我们收集了最佳矫正视力(BCVA)的数据,黄斑中心厚度(CMT),视网膜内层的解体(DRIL),视网膜下液,视网膜内膀胱样变化(IRC),内外段层的完整性,和眼压。
结果:两组BCVA均有显著改善;DEX组在1个月和6个月时视力增加较高(P分别为0.002和0.023)。两组术后CMT逐渐降低,DEX组在1个月和6个月时表现出更大的下降(分别为P=0.009和0.033)。手术后六个月,与PPV组相比,DEX组的DRIL和IRC评分显著改善(P=0.037和0.038).多因素回归分析显示,术中植入DEX的患者更有可能出现较基线显著的CMT降低(≥100μm)(比值比(OR),9.44;95%置信区间(CI),1.58-56.56;P=0.014)术后6个月出现DRIL的可能性较小(OR,0.08;95%CI,0.01-0.68;P=0.021)。
结论:晚期IERM患者行玻璃体切除联合玻璃体腔内植入DEX可促进术后视力恢复和解剖学结局的改善。有效降低CMT,提高DRIL。