伴或不伴玻璃体内注射地塞米松植入物的行动性糖尿病性视网膜脱离手术：TRADITION 研究。

TRActional DIabetic reTInal detachment surgery with co-adjuvant intravitreal dexamethasONe implant: the TRADITION STUDY.

机构信息

Private Retina Service, University of Buenos Aires, 525 Aguirre St., 3rd Floor, Apt. A, 1414, Buenos Aires, Argentina.

Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

出版信息

Acta Diabetol. 2019 Oct;56(10):1141-1147. doi: 10.1007/s00592-019-01357-y. Epub 2019 May 14.

DOI:10.1007/s00592-019-01357-y

PMID:31089929

Abstract

AIM

Main failure of diabetic tractional retinal detachment (TRD) surgery is the development of proliferative vitreoretinopathy (PVR), causing higher re-detachment rates. We investigated whether the use of dexamethasone (DEX) implant at the end of pars plana vitrectomy (PPV) with silicone oil tamponade might have an impact on these outcomes.

DESIGN

Comparative, nonrandomized, retrospective study.

PARTICIPANTS

A total of 148 eyes from 148 patients that underwent PPV with silicone oil tamponade for diabetic TRD (with DEX implant, n = 52; without DEX implant, n = 96).

METHODS

Consecutive patients' records were reviewed for time between TRD diagnosis and surgery; lens status before surgery and after 6, 12, and 24 months; retina attachment rate after primary PPV; change in postoperative PVR severity; rate of re-detachment at 6, 12, and 24 months; use of IOP lowering treatment after 6, 12, and 24 months; surgery details; intra- and postoperative complications. Correlations between outcome measures, postoperative PVR severity, and re-detachment rates were analyzed.

MAIN OUTCOME MEASURES

Change in postoperative PVR severity and retinal re-detachment rates with and without the adjuvant use of DEX implant.

RESULTS

Retinal re-detachment rates were significantly higher in the group of patients that did not receive DEX implant [11/96 (11.5%) vs. 0/52 (0%), p = 0.049; 11/84 (12.9%) vs. 4/52 (7.7%), p = 0.007; 14/71 (19.7%) vs. 5/52 (10%) p < 0.001 at 6, 12, and 24 months, respectively]. PVR severity correlated with retinal status at 12 and 24 months (p = 0.018 and p = 0.027, respectively). The difference in PVR severity between the two groups was statistically significant at 6, 12, and 24 months (p < 0.001).

CONCLUSIONS

DEX implant at the end of PPV in patients with diabetic TRD improves PVR severity and decreases re-detachment rates. This should be considered as an option in the customized treatment of TRD.

摘要

目的

糖尿病牵引性视网膜脱离（TRD）手术的主要失败原因是增生性玻璃体视网膜病变（PVR）的发展，导致更高的再脱离率。我们研究了在硅油眼内填充的情况下，在经睫状体平坦部玻璃体切除术（PPV）结束时使用地塞米松（DEX）植入物是否会对这些结果产生影响。

设计

比较、非随机、回顾性研究。

参与者

共有 148 名接受硅油眼内填充的糖尿病 TRD 患者的 148 只眼（DEX 植入组，n=52；无 DEX 植入组，n=96）接受了 PPV 治疗。

方法

连续患者记录接受 TRD 诊断和手术的时间；手术前和手术后 6、12 和 24 个月的晶状体状态；初次 PPV 后的视网膜附着率；术后 PVR 严重程度的变化；6、12 和 24 个月时的再脱离率；6、12 和 24 个月后使用降眼压治疗；手术细节；术中及术后并发症。分析术后 PVR 严重程度和再脱离率与结果测量之间的相关性。

主要观察指标

使用和不使用 DEX 植入物时，术后 PVR 严重程度和视网膜再脱离率的变化。

结果

未接受 DEX 植入的患者组视网膜再脱离率明显更高[96 例中 11 例（11.5%） vs. 52 例中 0 例（0%），p=0.049；84 例中 11 例（12.9%） vs. 52 例中 4 例（7.7%），p=0.007；71 例中 14 例（19.7%） vs. 52 例中 5 例（10%），p<0.001，分别在 6、12 和 24 个月]。PVR 严重程度与 12 和 24 个月时的视网膜状态相关（p=0.018 和 p=0.027）。两组之间的 PVR 严重程度差异在 6、12 和 24 个月时具有统计学意义（p<0.001）。