Kim Jae Hui, Kang Se Woong, Ha Hyo Shin, Kim Jae Ryung
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2013 Jun;27(3):186-93. doi: 10.3341/kjo.2013.27.3.186. Epub 2013 Apr 25.
To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy.
Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both.
The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 ± 0.15, 0.36 ± 0.18, 0.31 ± 0.14, and 0.34 ± 0.22, respectively. The mean CSTs were 433.3 ± 77.9, 329.9 ± 59.4, 307.2 ± 60.2, and 310.1 ± 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012).
Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.
评估玻璃体切除术联合玻璃体内注射曲安奈德（IVTA）及黄斑区激光光凝治疗抗血管内皮生长因子（VEGF）治疗无效的非牵拉性糖尿病性黄斑水肿（DME）的疗效。
28例被诊断为非牵拉性DME且接受三次或更多次连续抗VEGF注射治疗无效的患者的28只眼，接受了连续的玻璃体切除术、IVTA及黄斑区激光光凝治疗。评估玻璃体切除术后六个月内最佳矫正视力（BCVA）和中心子野厚度（CST）的变化。此外，将CST和BCVA结果与26只接受相同三联疗法治疗的非牵拉性DME眼进行比较，这些患者对常规治疗（如IVTA或黄斑区激光光凝或两者）无效。
玻璃体切除术前及术后1个月、3个月和6个月的最小分辨角对数平均BCVA分别为0.44±0.15、0.36±0.18、0.31±0.14和0.34±0.22。平均CST分别为433.3±77.9、329.9±59.4、307.2±60.2和310.1±80.1微米。术后1个月、3个月和6个月的BCVA和CST值均较基线显著改善（p<0.05）。三联疗法后第一个月，常规治疗无效的眼CST降低程度大于抗VEGF治疗无效的眼（p=0.012）。
玻璃体切除术联合IVTA及黄斑区激光光凝对抗VEGF治疗无效的非牵拉性DME眼的解剖和功能预后均有有益影响。
