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与玻璃体腔内注射曲安奈德相比,玻璃体后段玻璃体切除术联合内界膜剥除术治疗糖尿病性黄斑水肿的疗效观察

Pars plana vitrectomy with internal limiting membrane peeling compared with intravitreal triamcinolone injection in the treatment of diabetic macular edema.

作者信息

Kim Yong Min, Chung Eun Jee, Byeon Suk Ho, Lee Sung Chul, Kwon Oh Woong, Koh Hyoung Jun

机构信息

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Ophthalmologica. 2009;223(1):17-23. doi: 10.1159/000161878. Epub 2008 Oct 13.

Abstract

AIM

To compare the efficacy of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) removal and intravitreal triamcinolone acetonide (IVTA) injection in patients with diabetic macular edema (DME).

METHODS

This study was a retrospective, comparative, interventional case study examining 14 patients (15 eyes in total) who underwent PPV and ILM removal (vitrectomy group), and 14 patients (14 eyes in total) who were treated with an IVTA injection (triamcinolone group). Main outcome measures were visual acuity and central macular thickness at 1, 3 and 6 months postoperatively.

RESULTS

Patients in the vitrectomy group had significantly decreased central macular thicknesses at 1, 3 and 6 months postoperatively (p = 0.001, p = 0.001 and p = 0.002, respectively). The improvement in visual acuity was not significant at 1 month, but it gradually became statistically significant at 3 and 6 months after surgery (p = 0.031 and p = 0.015, respectively). Compared with the triamcinolone group, the vitrectomy group showed a better visual acuity at 6 months after surgery (p = 0.025).

CONCLUSIONS

PPV combined with ILM removal is a good therapeutic option for improving visual acuity and decreasing macular thickness in DME, and this treatment has a better long-term efficacy than a single IVTA injection.

摘要

目的

比较玻璃体切除术(PPV)联合内界膜(ILM)剥除术与玻璃体内注射曲安奈德(IVTA)治疗糖尿病性黄斑水肿(DME)患者的疗效。

方法

本研究为回顾性、对比性、干预性病例研究,纳入14例患者(共15只眼)接受PPV联合ILM剥除术(玻璃体切除术组),以及14例患者(共14只眼)接受IVTA注射治疗(曲安奈德组)。主要观察指标为术后1、3和6个月时的视力及黄斑中心厚度。

结果

玻璃体切除术组患者术后1、3和6个月时黄斑中心厚度均显著降低(分别为p = 0.001、p = 0.001和p = 0.002)。术后1个月时视力改善不显著,但在术后3个月和6个月时逐渐具有统计学意义(分别为p = 0.031和p = 0.015)。与曲安奈德组相比,玻璃体切除术组术后6个月时视力更佳(p = 0.025)。

结论

PPV联合ILM剥除术是改善DME患者视力及降低黄斑厚度的良好治疗选择,且该治疗的长期疗效优于单纯IVTA注射。

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