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Abstract：
OBJECTIVE: To investigate the effects of vitrectomy and intravitreal dexamethasone (DEX) implantation on retinal biomarkers in patients with advanced idiopathic epiretinal membrane (IERM) and to evaluate this treatment\'s anatomical and functional outcomes.
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.
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.
摘要：
目的：研究玻璃体切除术和玻璃体内地塞米松（DEX）植入对晚期特发性视网膜前膜（IERM）患者视网膜生物标志物的影响，并评估该治疗的解剖和功能结局。
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。
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。
