Kim Seonghwan, Kim Mee Kum, Wee Won Ryang
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
Korean J Ophthalmol. 2017 Oct;31(5):394-401. doi: 10.3341/kjo.2016.0109. Epub 2017 Aug 18.
To investigate the additive effect of oral steroid with topical nonsteroidal anti-inflammatory drug (NSAID) on cystoid macular edema (CME) in patients with epiretinal membrane (ERM) after cataract surgery.
Medical records of subjects who underwent uneventful cataract surgery (n = 1,349) were retrospectively reviewed; among these patients, those with pre-existing ERM (n = 81) were included. Patients were divided into two groups: one group had postoperative administration of oral steroid for 1 week (n = 45) and the other group did not have oral steroid administration (n = 36). Changes in macular thickness and incidence of CME were compared in both groups. Topical NSAIDs were administered in both groups for 1 month postoperatively. Definite CME and probable CME were defined by changes in retinal contour with or without cystoid changes. Change in central macular thickness of more than three standard deviations (≥90.17 μm) was defined as possible CME. Macular thickness was measured at 1 month after the operation by optical coherence tomography.
The incidence of definite, probable, and possible CME were 2.22%, 4.44%, and 8.89% with the use of steroid and 2.78%, 5.56%, and 8.33% without steroid, respectively (p = 0.694, p = 0.603, and p = 0.625), and regardless of treatment group, the incidences in these patients were higher compared to incidences in whole subjects (1.26%, 2.30%, and 4.32%; p = 0.048, p = 0.032, and p = 0.038, respectively). The differences in macular thickness were not statistically different between the two groups. Average changes of central foveal thickness in 3 mm and 6 mm zone were 29.29 μm, 35.93 μm, and 38.02 μm with the use of steroid and 32.25 μm, 44.08 μm, and 45.39 μm without steroid (p = 0.747, p = 0.148, and p = 0.077, respectively).
This study suggests that administration of oral steroid may not have a synergistic effect in reduction of CME and retinal thickness in patients with pre-existing ERM after cataract surgery, when topical NSAIDs are applied.
探讨口服类固醇与局部非甾体抗炎药（NSAID）联合应用对白内障手术后视网膜前膜（ERM）患者黄斑囊样水肿（CME）的附加作用。
回顾性分析1349例行白内障手术且过程顺利患者的病历；其中纳入术前已存在ERM的患者81例。患者分为两组：一组术后口服类固醇1周（n = 45），另一组未口服类固醇（n = 36）。比较两组黄斑厚度变化及CME发生率。两组术后均局部应用NSAIDs 1个月。明确的CME和可能的CME根据有无囊样改变的视网膜轮廓变化来定义。中心黄斑厚度变化超过三个标准差（≥90.17μm）定义为可能的CME。术后1个月通过光学相干断层扫描测量黄斑厚度。
使用类固醇时明确的、可能的和可能的CME发生率分别为2.22%、4.44%和8.89%，未使用类固醇时分别为2.78%、5.56%和8.33%（p = 0.694、p = 0.603和p = 0.625），且无论治疗组如何，这些患者的发生率均高于全部受试者的发生率（分别为1.26%、2.30%和4.32%；p = 0.048、p = 0.032和p = 0.038）。两组间黄斑厚度差异无统计学意义。使用类固醇时3mm和6mm区域中心凹厚度的平均变化分别为29.29μm、35.93μm和38.02μm，未使用类固醇时分别为32.25μm、44.08μm和45.39μm（分别为p = 0.747、p = 0.148和p = 0.077）。
本研究表明，在应用局部NSAIDs时，口服类固醇对白内障手术后术前已存在ERM的患者减少CME和视网膜厚度可能没有协同作用。
