背景:青光眼手术后最常见的视网膜并发症是脉络膜脱离,低张力黄斑病变,恶性青光眼,玻璃体出血,眼内炎和视网膜脱离。然而,如果青光眼手术是ERM发展的危险因素,则需要明确.这项研究旨在评估接受Ex-Press分流植入物治疗的原发性开角型青光眼(POAG)患者在2年随访中视网膜前膜(ERM)的发生率。
方法:前瞻性,连续的,单中心,病例对照研究。我们招募了受POAG影响的患者,并计划进行Ex-Press设备植入,伴或不伴白内障手术。对照组是继续抗青光眼滴眼液的对侧眼睛。术前进行完整的眼科评估和谱域光学相干断层扫描,随访6个月和24个月。
结果:41例连续患者的82只眼,在24个月时分析了18名男性和23名女性,平均年龄为70,29±8,45。39.1%的眼睛发生ERM:29.3%为玻璃纸黄斑反射(CMR),9.8%为黄斑前纤维化(PMF)。在对照组中,19.5%的眼睛发生ERM:17.1%为CMR,2.4%为PMF。治疗组和对照组之间没有统计学上的显著差异(p=0.121)。ERM的发展并不显著影响中央凹厚度(基线时260.13±35.01μm,6个月时265.03±34.90μm,24个月时275.18±33.31μm)和黄斑体积(基线时7.75±0.43mm3,6个月时为7.77±0.48mm3,24个月时为7.77±0.46mm3),在随访期间,保持与健康个体报告的平均测量值相当。伴随白内障手术并未增加ERM发生率。
结论:无论是否伴随白内障手术,Ex-Press植入物都可能增加ERM发生率,加速或诱导玻璃体后脱离,如其他眼外科手术。然而,绝大多数企业风险管理是CMR,不影响黄斑轮廓。
BACKGROUND: The most common retinal complications after glaucoma surgery are choroidal detachment, hypotony maculopathy, malignant glaucoma, vitreous hemorrhage, endophthalmitis and retinal detachment. However, if glaucoma surgery is a risk factor for the ERM development needs to be clarified. This study aims to assess the incidence of epiretinal membrane (ERM) in 2 years of follow-up in patients with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant.
METHODS: A prospective, consecutive, single-center,
case-control study. We enrolled patients affected by POAG and scheduled for Ex-Press device implant with or without concomitant cataract surgery. The control group was the contralateral eyes which continues anti-glaucomatous eyedrops. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography were performed before surgery, at 6 months and 24 months of follow-up.
RESULTS: Eighty-two eyes of 41 consecutive patients, 18 males and 23 females with a mean age of 70, 29 ± 8,45, were analyzed at 24 months. 39.1% of eyes developed ERM: 29.3% were cellophane macular reflex (CMR) and 9.8% were pre-macular fibrosis (PMF). In the control group, 19.5% of eyes developed ERM: 17.1% were CMR and 2.4% were PMF. No statistically significant difference was reported (p = 0.121) between treated and control group. ERM development did not affect significantly the central foveal thickness (260.13 ± 35.01 μm at baseline, 265.03 ± 34.90 μm at 6 months and 275.18 ± 33.31 μm at 24 months) and macular volume (7.75 ± 0.43 mm3 at baseline, 7.77 ± 0.48 mm3 at 6 months and 7.77 ± 0.46 mm3 at 24 months), remained comparable to reported average measures in healthy individuals during the follow-up. Concomitant cataract surgery did not increase the ERM incidence.
CONCLUSIONS: Ex-Press implant may increase the ERM incidence regardless concomitant cataract surgery, accelerating or inducing a posterior vitreous detachment, such as other ocular surgical procedure. Nevertheless, the vast majority of ERM are CMR, not affecting the macular profile.