Ilveskoski Lotta, Taipale Claudia, Holmström Emil J, Tuuminen Raimo
Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.
Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland.
Eur J Ophthalmol. 2019 Sep;29(5):504-509. doi: 10.1177/1120672118799622. Epub 2018 Sep 12.
The purpose of the study was to identify macular edema after cataract surgery in eyes with and without pseudoexfoliation syndrome. The study was a post-hoc analysis of a randomized, double-blind, prospective single-center study. Patients were enrolled between January 2016 and October 2016 as per the national guidelines for the management of cataract in the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.
One hundred and fifty-six eyes of 149 patients undergoing routine cataract surgery. Postoperatively anti-inflammatory medication was either dexamethasone (N = 78) or diclofenac (N = 78). Spectral domain optical coherence tomography imaging and laser flare meter measurement of the anterior chamber were conducted before surgery and at the control visit 28 days postoperatively.
Baseline variables were comparable between eyes with pseudoexfoliation syndrome (N = 32) and those without (N = 124), except for intraocular pressure ( = 0.002) and glaucoma medication ( < 0.001). In patients having pseudoexfoliation syndrome, central retinal thickness increase (mean ± standard error of the mean) was 63.3 ± 35.5 μm for dexamethasone and 17.6 ± 5.8 μm for diclofenac, compared to 28.9 ± 8.0 μm ( = NS) and 6.9 ± 1.3 μm ( = 0.014) in eyes without pseudoexfoliation syndrome, respectively. Aqueous flare at 28 days was 25.8 ± 5.4 pu/ms for patients with pseudoexfoliation syndrome and 18.3 ± 1.8 pu/ms for those without ( = 0.030). Best corrected visual acuity gain and best corrected visual acuity at 28 days were less in patients having pseudoexfoliation syndrome compared to those without (0.39 ± 0.07 vs 0.59 ± 0.03 decimals, = 0.007; and 0.77 ± 0.06 vs 0.92 ± 0.03 decimals, = 0.008, respectively).
Eyes with pseudoexfoliation syndrome may be predisposed to an increased aqueous flare and macular edema after cataract surgery. This study outlines the need to determine the optimal anti-inflammatory medication after cataract surgery in patients with pseudoexfoliation syndrome.
本研究的目的是确定有无假性剥脱综合征的眼睛在白内障手术后黄斑水肿的情况。该研究是一项对随机、双盲、前瞻性单中心研究的事后分析。根据芬兰科特卡市屈米拉克索中央医院眼科白内障管理的国家指南，于2016年1月至2016年10月招募患者。
149例接受常规白内障手术的患者共156只眼。术后抗炎药物为地塞米松（N = 78）或双氯芬酸（N = 78）。在手术前和术后28天的对照访视时进行前房的光谱域光学相干断层扫描成像和激光散射仪测量。
除眼压（P = 0.002）和青光眼药物治疗情况（P < 0.001）外，假性剥脱综合征患者的眼睛（N = 32）和无该综合征患者的眼睛（N = 124）之间基线变量具有可比性。在患有假性剥脱综合征的患者中，地塞米松治疗组中心视网膜厚度增加（平均值±平均标准误差）为63.3±35.5μm，双氯芬酸治疗组为17.6±5.8μm，而在无假性剥脱综合征的眼睛中，相应数值分别为28.9±8.0μm（P = 无显著性差异）和6.9±1.3μm（P = 0.014）。假性剥脱综合征患者术后28天的房水闪光值为25.8±5.4 pu/ms，无该综合征患者为18.3±1.8 pu/ms（P = 0.030）。与无假性剥脱综合征的患者相比，患有该综合征的患者在术后28天的最佳矫正视力提高幅度和最佳矫正视力更低（分别为0.39±0.07对0.59±0.03对数视力，P = 0.007；以及0.77±0.06对0.92±0.03对数视力，P = 0.008）。
患有假性剥脱综合征的眼睛在白内障手术后可能更容易出现房水闪光增加和黄斑水肿。本研究概述了确定假性剥脱综合征患者白内障手术后最佳抗炎药物的必要性。
