硅油或重水取出术后玻璃体视网膜牵引的分辨率比较。
COMPARISON OF RESOLUTION OF VITREOMACULAR TRACTION AFTER OCRIPLASMIN TREATMENT OR VITRECTOMY.
机构信息
Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland.
出版信息
Retina. 2019 Jan;39(1):180-185. doi: 10.1097/IAE.0000000000001926.
PURPOSE
To compare the functional and morphologic outcome of patients with vitreomacular traction (VMT) treated with either ocriplasmin treatment or vitrectomy.
METHODS
Retrospective case series of patients treated with ocriplasmin or vitrectomy for VMT.
OUTCOME MEASURES
resolution of VMT, change in outer retinal thickness, integrity of ellipsoid zone, subretinal fluid formation, and best-corrected visual acuity 2 weeks and 4 months after treatment.
RESULTS
Fourteen eyes received ocriplasmin (Group 1). Vitreomacular traction resolved in 50% (Group 1a), and in 50%, it did not (Group 1b). Ten eyes underwent vitrectomy (Group 2). Vitreomacular traction resolved in 100%. Outer retinal thickness decreased significantly 2 weeks after treatment in Group 1 (P = 0.003) and in 1a (P = 0.018). Two weeks after treatment, Group 1a showed a disruption of the ellipsoid zone (P = 0.001) and subretinal fluid formation (P = 0.01) more often than 1b. Neither was observed 4 months after treatment. Best-corrected visual acuity decreased significantly in Groups 1 (P = 0.034) and 1a (P = 0.026).
CONCLUSION
Most patients treated with ocriplasmin for VMT showed a transient reduction of best-corrected visual acuity, accumulation of subretinal fluid, and a loss of the ellipsoid zone after the resolution of VMT. Patients with surgical resolution of VMT did not show these findings. The advantage of a less-invasive intravitreal injection of ocriplasmin must be weighed against the lower success rate, the (transient) morphologic changes, and the uncertain visual benefit.
目的
比较玻璃体内注射 ocriplasmin 与玻璃体切割术治疗玻璃体黄斑牵引（VMT）的功能和形态学结果。
方法
回顾性系列病例研究，对接受 ocriplasmin 或玻璃体切割术治疗 VMT 的患者进行分析。
观察指标
VMT 缓解情况、外视网膜厚度变化、椭圆体带完整性、视网膜下液形成和治疗后 2 周及 4 个月最佳矫正视力。
结果
14 只眼接受 ocriplasmin 治疗（第 1 组）。50%（第 1a 组）的 VMT 得到缓解，50%（第 1b 组）未缓解。10 只眼接受玻璃体切割术（第 2 组）。100%的 VMT 得到缓解。第 1 组治疗后 2 周外视网膜厚度显著降低（P = 0.003），1a 组也显著降低（P = 0.018）。治疗后 2 周，第 1a 组的椭圆体带断裂（P = 0.001）和视网膜下液形成（P = 0.01）较第 1b 组更常见。治疗后 4 个月未观察到上述变化。第 1 组（P = 0.034）和第 1a 组（P = 0.026）的最佳矫正视力显著下降。
结论
大多数接受 ocriplasmin 治疗 VMT 的患者在 VMT 缓解后会出现短暂的最佳矫正视力下降、视网膜下液积聚和椭圆体带丢失。VMT 手术缓解的患者没有出现这些发现。玻璃体内注射 ocriplasmin 的微创优势必须与较低的成功率、（短暂的）形态学改变和不确定的视力获益相权衡。
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