Lee Kyoung Min, Lee Eun Ji, Kim Tae-Woo, Kim Hyunjoong
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea.
Am J Ophthalmol. 2017 Jul;179:97-109. doi: 10.1016/j.ajo.2017.05.001. Epub 2017 May 10.
To determine the incidence of and risk factors for pseudophakic macular edema (PME) after uncomplicated cataract surgery in primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (SDOCT).
Cohort study.
Macular retinal thickness was evaluated using SDOCT at 1 week before surgery and at 1, 3, 6, and 12 months postoperatively, in 70 POAG and 68 control eyes. Forty-three healthy subjects without impaired vision or cystoid PME were recruited separately as pilot samples to define significant PME. Significant PME was defined as an increase in the average thickness exceeding the mean + 3 standard deviations of the increase shown in the pilot samples.
Significant PME (increase in the foveal 3-mm zone thickness of >19.5 μm) was observed in 31 (44%) eyes with POAG and in 14 (21%) control eyes (P = .003). The extent of PME was maximal at 3 months postoperatively and decreased gradually until 12 months. Regression tree analysis revealed that the risk of PME was the greatest in the POAG group using prostaglandin analogue (PGA) (odds ratio [OR] = 5.51), followed by POAG not using PGA (OR = 1.70), and control group (OR = 1.0). Risk factors for PME were younger age in all groups (OR = 1.07), systemic hypertension in PGA users (OR = 6.42), higher untreated IOP in PGA nonusers (OR = 1.09) and male sex (OR = 14.06) and diabetes mellitus (OR = 16.71) in the control group.
The incidence of PME as observed by SDOCT was higher than previously reported after uncomplicated cataract surgery. Eyes with POAG were at greater risk for PME, which was mainly associated with perioperative PGA use.
使用频域光学相干断层扫描（SDOCT）确定原发性开角型青光眼（POAG）患者在进行无并发症白内障手术后发生人工晶状体性黄斑水肿（PME）的发生率及危险因素。
队列研究。
对70只POAG患眼和68只对照眼在术前1周以及术后1、3、6和12个月使用SDOCT评估黄斑视网膜厚度。另外招募了43名视力未受损且无囊样PME的健康受试者作为试点样本以定义显著PME。显著PME定义为平均厚度增加超过试点样本中所示增加量的均值 + 3个标准差。
在31只（44%）POAG患眼中观察到显著PME（中央凹3毫米区域厚度增加>19.5μm），在14只（21%）对照眼中观察到显著PME（P = 0.003）。PME的程度在术后3个月时最大，随后逐渐下降直至12个月。回归树分析显示，使用前列腺素类似物（PGA）的POAG组发生PME的风险最高（比值比[OR]=5.51），其次是未使用PGA的POAG组（OR = 1.70），对照组（OR = 1.0）。PME的危险因素在所有组中均为年龄较小（OR = 1.07），PGA使用者中的系统性高血压（OR = 6.42），未使用PGA者中较高的未治疗眼压（OR = 1.09），对照组中的男性（OR = 14.06）和糖尿病（OR = 16.71）。
通过SDOCT观察到的PME发生率高于先前报道的无并发症白内障手术后的发生率。POAG患眼发生PME的风险更高，这主要与围手术期使用PGA有关。
