Nishida Akihiro, Kojima Hiroshi, Kameda Takanori, Mandai Michiko, Kurimoto Yasuo
Department of Ophthalmology, Kobe City Medical Center General Hospital; Department of Ophthalmology, Institute of Biomedical Research and Innovation.
Department of Ophthalmology, Kobe City Medical Center General Hospital; Laboratory for Retinal Regeneration, RIKEN Center for Developmental Biology, Chuo-ku, Kobe, Hyogo, Japan.
Clin Ophthalmol. 2017 Feb 17;11:369-375. doi: 10.2147/OPTH.S123419. eCollection 2017.
Long-term outcomes of pars plana vitrectomy (PPV) for macular edema (ME) associated with branch retinal vein occlusion (BRVO) have been previously reported, but the studies did not report the number of additional treatments after surgery. During 5 years of follow-up, we therefore investigated the efficacy and safety of PPV for BRVO and evaluated the incidence of additional treatments.
We retrospectively reviewed the medical records of 25 eyes of 24 patients who underwent PPV for ME associated with BRVO and were followed up for at least 5 years. Best-corrected visual acuity was measured, and foveal thickness was assessed by optical coherence tomography. Additional treatments were also investigated.
The logarithm of the minimal angle of resolution (logMAR) improved from 0.53±0.23 at baseline to 0.16±0.25 at 5 years (<0.0001). The foveal thickness decreased from 535±222 µm at baseline to 205±143 µm at 5 years (<0.0001). For the eyes with residual ME, the following additional treatments were performed within 5 years of follow-up: sub-Tenon injection of triamcinolone acetonide in two eyes, intravitreal injection of bevacizumab in three eyes, grid laser photocoagulation in one eye, and direct photocoagulation of macroaneurysm in one eye. Additional surgeries were performed in two eyes: for one eye, phacoemulsification extraction of the ocular lens and intraocular lens implantation were performed because of cataract progression, and for the other eye, additional PPV was done for postoperative retinal detachment.
PPV was effective for resolution of ME associated with BRVO and improved visual acuity with a small number of additional treatments during long-term follow-up.
此前已有关于黄斑水肿（ME）合并视网膜分支静脉阻塞（BRVO）行玻璃体切割术（PPV）的长期预后报道，但这些研究未报告术后额外治疗的次数。因此，在5年的随访期间，我们调查了PPV治疗BRVO的有效性和安全性，并评估了额外治疗的发生率。
我们回顾性分析了24例因ME合并BRVO接受PPV治疗且至少随访5年的患者的25只眼的病历。测量最佳矫正视力，并用光学相干断层扫描评估黄斑中心凹厚度。还对额外治疗情况进行了调查。
最小分辨角对数（logMAR）从基线时的0.53±0.23改善至5年时的0.16±0.25（<0.0001）。黄斑中心凹厚度从基线时的535±222μm降至5年时的205±143μm（<0.0001）。对于残留ME的眼睛，在随访的5年内进行了以下额外治疗：2只眼行Tenon囊下注射曲安奈德，3只眼玻璃体内注射贝伐单抗，1只眼行格栅样激光光凝，1只眼对大动脉瘤进行直接光凝。2只眼进行了额外手术：1只眼因白内障进展行晶状体超声乳化摘除联合人工晶状体植入术，另1只眼因术后视网膜脱离行再次PPV。
PPV对BRVO合并ME的消退有效，且在长期随访期间通过少量额外治疗提高了视力。
