目的:本研究的目的是评估玻璃体内地塞米松(DEX)植入物治疗平坦部玻璃体切除术(PPV)和去除原发性视网膜前膜(ERM)后黄斑水肿(ME)的有效性和安全性,并评估椭圆形区(EZ)的完整性和视网膜内层解剖结构(DRIL)和视觉分级的影响。
方法:纳入42例假晶状体患者,这些患者在PPV和去除2-3期原发性ERM后发展为ME。当通过谱域光学相干断层扫描(SD-OCT)诊断ME时,将患者分为两组。在DEX组(n=22)中,植入DEX治疗ME。在对照组(n=20)中,只进行了观察,没有任何治疗。比较两组患者基线及DEX植入后1、6、12个月的最佳矫正视力(BCVA)和黄斑厚度(MT)。还评估了OCT参数如EZ完整性和DRIL等级的影响,即在DEX植入治疗ME时MT的减少和VA的增加。眼内压(IOP),还记录了DEX的种植数量和不良反应.
结果:虽然在DEX组中观察到平均BCVA的统计学显着增加(分别在1、6和12个月时p<0.001),与基线相比,对照组(分别在第1,6和12个月时p=0.169,p=0.065和p=0.058)未检测到此类增加.在DEX组中观察到平均MT的统计学显着下降(在1、6和12个月时p<0.001);然而,对照组与基线相比无显著差异(分别在第1,6和12个月时p=0.081,p=0.065和p=0.054).两组在所有访视时BCVA增加(p<0.01)和MT减少(p<0.01)均有显著差异,DEX组的结果更有利。在两组中,VA和EZ完整性的增加与DRIL等级之间存在统计学上的显着关系。10名患者(45.4%)在随访期间接受了两次DEX注射。在接受局部抗青光眼滴剂治疗的五名患者(22.7%)中观察到IOP增加。没有观察到明显的副作用。
结论:发现DEX植入治疗PPV和原发性ERM后的ME是有效和安全的。尽管有些眼睛可能需要反复注射才能获得视觉和解剖学上的成功。此外,发现了EZ完整性之间的关系,DRIL等级和视觉解剖结果。
OBJECTIVE: The purpose of this study was to evaluate the effectiveness and safety of an intravitreal dexamethasone (DEX) implant for the treatment of macular edema (ME) following pars plana vitrectomy (PPV) and removal of the primary epiretinal membrane (ERM) and to assess the impact of the integrity of the ellipsoid zone (EZ) and disorganization of the retinal inner layer (DRIL) grade on visual and anatomical outcomes.
METHODS: Forty-two pseudophakic patients who developed ME following PPV and removal of the primary stage 2-3 ERM were included. Patients were divided into two groups when ME was diagnosed via spectral domain optic coherence tomography (SD-OCT). In the DEX group (n = 22), DEX was implanted for the treatment of ME. In the control group (n = 20), only observation was conducted, without any treatment. The best-corrected visual acuity (BCVA) and macular thickness (MT) of the two groups were compared at baseline and 1, 6, and 12 months after DEX implantation. The effects of OCT parameters such as EZ integrity and DRIL grade were also evaluated in terms of decreases in MT and increases in VA in the treatment of ME with DEX implantation. Intraocular pressure (IOP), number of DEX implantations and adverse effects were also recorded.
RESULTS: While a statistically significant increase in the mean BCVA was observed in the DEX group (p < 0.001 at months 1, 6, and 12, respectively), no such increase was detected in the control group (p = 0.169, p = 0.065, and p = 0.058 at months 1, 6 and 12, respectively) compared with the baseline. A statistically significant decrease in the mean MT was observed in the DEX group (p < 0.001 at months 1, 6, and 12); however, no significant difference was observed in the control group (p = 0.081, p = 0.065, and p = 0.054 at months 1, 6 and 12, respectively) compared with the baseline. Significant differences were found between the two groups in terms of the increase in BCVA (p < 0.01) and decrease in MT (p < 0.01) at all visits, with the outcomes being more favorable in the DEX group. A statistically significant relationship was found between the increase in VA and EZ integrity and DRIL grade in both groups. Ten patients (45.4%) received two injections of DEX during the follow-up. An increase in IOP was observed in five patients (22.7%) who were treated with topical antiglaucomatous drops. No significant side effects were observed.
CONCLUSIONS: DEX implantation was found to be effective and safe for the treatment of ME following PPV and primary ERM removal, although some eyes may require repeated injections to achieve visual and anatomical success. Additionally, a relationship was found between EZ integrity, DRIL grade and visual-anatomical outcomes.