Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
Adv Ther. 2017 Sep;34(9):2139-2149. doi: 10.1007/s12325-017-0598-4. Epub 2017 Aug 14.
The purpose of this study was to evaluate baseline and postoperative factors affecting outcomes after vitrectomy for diabetic macular edema (DME) using optical coherence tomography (OCT).
Vitrectomy combined with inner limiting membrane (ILM) peeling and additional laser photocoagulation therapy was performed on 36 eyes of 30 DME patients. Evaluations included the logarithm of the minimal angle of resolution (logMAR), best-corrected visual acuity (BCVA) and OCT parameters at baseline and 1, 3, 6, and 12 months postoperatively. Correlations between OCT parameters and BCVA were assessed at each follow-up visit. Correlations among postoperative BCVA and preoperative BCVA, foveal macular thickness (FMT), outer foveal thickness (OFT), and photoreceptor outer segment (PROS) length were evaluated using multiple regression analysis.
BCVA significantly improved from 0.50 ± 0.25 to 0.34 ± 0.26 at 12 months postoperatively (P < 0.001). Mean FMT improved significantly from 526.4 ± 120.4 to 384.6 ± 120.5 at 1 month, 325.2 ± 100.3 at 3 months, 304.1 ± 102.5 at 6 months and 274.2 ± 86.6 μm at 12 months postoperatively (P < 0.001, respectively). OFT 1 month after surgery was significantly decreased 46.5 ± 14.7-40.2 ± 14.4 μm (P = 0.017), although at 3, 6, and 12 months it did not differ from the baseline value. PROS length 1 month after surgery significantly decreased from 31.7 ± 6.9-28.8 ± 6.8 μm (P = 0.015) and that at 3 months and 6 months recovered to the baseline value. PROS length 12 months after surgery was significantly increased to 34.3 ± 7.2 μm from baseline (P = 0.023). Mean FMT was not correlated with BCVA at any time point. Mean OFT and PROS length at 3, 6, and 12 months were correlated with BCVA. In multiple regression analysis, PROS length had the greatest effect on VA 12 months postoperatively (P = 0.0262, standard regression coefficient = -0.366).
Current surgery helps DME patients to maintain VA and foveal structures. The results suggest that PROS length predicts visual outcome in DME patients following vitrectomy with ILM peeling and additional laser photocoagulation.
本研究旨在通过光学相干断层扫描（OCT）评估糖尿病性黄斑水肿（DME）患者玻璃体切割术后影响视力结果的基线和术后因素。
对 30 例 DME 患者的 36 只眼行玻璃体切割术联合内界膜（ILM）剥除和附加激光光凝治疗。评估包括最小分辨角对数（logMAR）、最佳矫正视力（BCVA）和基线及术后 1、3、6 和 12 个月的 OCT 参数。在每次随访时评估 OCT 参数与 BCVA 之间的相关性。采用多元回归分析评估术后 BCVA 与术前 BCVA、黄斑中心凹视网膜厚度（FMT）、外核层黄斑厚度（OFT）和光感受器外节（PROS）长度之间的相关性。
术后 12 个月 BCVA 从 0.50 ± 0.25 显著提高至 0.34 ± 0.26（P < 0.001）。术后 1 个月平均 FMT 从 526.4 ± 120.4 显著改善至 384.6 ± 120.5、3 个月时 325.2 ± 100.3、6 个月时 304.1 ± 102.5、12 个月时 274.2 ± 86.6μm（P < 0.001）。术后 1 个月 OFT 显著下降 46.5 ± 14.7-40.2 ± 14.4μm（P = 0.017），尽管在 3、6 和 12 个月时与基线值无差异。术后 1 个月 PROS 长度显著下降 31.7 ± 6.9-28.8 ± 6.8μm（P = 0.015），而在 3 个月和 6 个月时恢复到基线值。术后 12 个月 PROS 长度显著增加至 34.3 ± 7.2μm，与基线相比（P = 0.023）。任何时间点的平均 FMT 均与 BCVA 无相关性。术后 3、6 和 12 个月的平均 OFT 和 PROS 长度与 BCVA 相关。多元回归分析显示，术后 12 个月 PROS 长度对 VA 的影响最大（P = 0.0262，标准回归系数=-0.366）。
目前的手术有助于 DME 患者维持视力和黄斑结构。结果表明，在玻璃体切割联合 ILM 剥除和附加激光光凝治疗 DME 患者中，术后 PROS 长度预测视力结果。
