Oregon Health and Science University, Portland, Oregon, USA.
Retina. 2010 Oct;30(9):1488-95. doi: 10.1097/IAE.0b013e3181e7974f.
To evaluate factors ¶associated with favorable outcomes after vitrectomy for diabetic macular edema.
Data were collected prospectively on 241 eyes undergoing vitrectomy for diabetic macular edema. Multivariate models were used to evaluate associations of 20 preoperative and intraoperative factors with 6-month outcomes of visual acuity and retinal thickness.
Median central subfield thickness decreased from 412 μm to 278 μm at 6 months, but median visual acuity remained unchanged (20/80, Snellen equivalent). Greater visual acuity improvement occurred in eyes with worse baseline acuity (P < 0.001) and in eyes in which an epiretinal membrane was removed (P = 0.006). Greater reduction in central subfield thickness occurred with worse baseline visual acuity (P < 0.001), greater preoperative retinal thickness (P = 0.001), removal of internal limiting membrane (P = 0.003), and optical coherence tomography evidence of vitreoretinal abnormalities (P = 0.006). No associations with clinician's preoperative assessments of the posterior vitreous were identified.
These results suggest that the removal of epiretinal membranes may favorably affect visual outcome after vitrectomy. Preoperative presence of vitreoretinal abnormalities appeared to be associated with somewhat greater reductions in retinal thickness but not with visual acuity outcome. These results may be useful for future studies evaluating vitrectomy for diabetic macular edema.
评估玻璃体切割术治疗糖尿病性黄斑水肿后获得良好结果的相关因素。
前瞻性收集 241 只接受玻璃体切割术治疗糖尿病性黄斑水肿的患眼数据。使用多变量模型评估 20 个术前和术中因素与术后 6 个月视力和视网膜厚度结果的相关性。
6 个月时，中央视网膜厚度的中位数从 412μm 下降至 278μm，但视力的中位数保持不变（20/80，Snellen 等价物）。基线视力较差的眼视力改善更大（P<0.001），并且存在视网膜内界膜（ERM）的眼视力改善更大（P=0.006）。基线视力越差（P<0.001）、术前视网膜厚度越大（P=0.001）、去除内界膜（P=0.003）和光学相干断层扫描（OCT）显示存在玻璃体视网膜异常（P=0.006），中央视网膜厚度的降低越大。与临床医生对后玻璃体的术前评估无相关性。
这些结果表明，去除 ERM 可能会对玻璃体切割术后的视力结果产生有利影响。术前存在玻璃体视网膜异常似乎与视网膜厚度的稍大程度降低有关，但与视力结果无关。这些结果可能对未来评估糖尿病性黄斑水肿的玻璃体切割术的研究有用。
