Someya Hideaki, Takayama Kei, Takeuchi Masaru, Yokoyama Hiroshi, Kimura Takeshi, Morioka Masakazu, Takamura Yoshihiro, Sameshima Seiji, Ueda Tetsuo, Ogata Nahoko, Tashiro Maki, Kitano Shigehiko, Sakamoto Taiji
Department of Ophthalmology, National Defense Medical College, Tokorozawa 359-8513, Japan.
Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida 910-1193, Japan.
J Ophthalmol. 2019 Dec 11;2019:5304524. doi: 10.1155/2019/5304524. eCollection 2019.
The benefit of pars plana vitrectomy with internal limiting membrane peeling for tractional macular edema and diffuse nontractional macular edema in diabetic retinopathy has been reported. Although these studies had included various stages, use of conventional 20-gauge vitrectomy system, small number of cases, single-center study, and lack of retinal structure measurements were limitations. We compared one-year outcomes of 25-gauge vitrectomy for refractory diabetic macular edema with or without the tractional proliferative membrane in proliferative diabetic retinopathy (PDR) eyes and examined the prognostic factors for postoperative visual acuity. A total of consecutive 116 PDR eyes of 116 patients that underwent 25-gauge vitrectomy for tractional macular edema (TME group: 56 eyes) or nontractional macular edema (nTME group: 60 eyes) at six centers were retrospectively reviewed. Visual acuity (VA), central macular thickness (CMT), complications, and postoperative treatments before and 12 months after vitrectomy were compared. Mean VA improved significantly in each group (both < 0.01), and mean CMT decreased significantly in each group (both < 0.01). Thirteen eyes underwent additional vitrectomy, six eyes developed neovascular glaucoma, six eyes received intravitreal anti-VEGF injection, and thirteen eyes received subtenon triamcinolone acetonide injection. Multiple linear regression analysis showed that baseline VA and CMT in the TME group and kidney function in the nTME group were the predictable factors of the 12-month postoperative VA. Twenty-five-gauge vitrectomy effectively improved VA and macular structure both in TME and nTME groups. Baseline VA, CMT, and kidney function are important factors affecting postoperative VA.
已报道了经平坦部玻璃体切除术联合内界膜剥除术治疗糖尿病性视网膜病变牵拉性黄斑水肿和弥漫性非牵拉性黄斑水肿的益处。尽管这些研究涵盖了各个阶段，但存在使用传统20G玻璃体切除系统、病例数量少、单中心研究以及缺乏视网膜结构测量等局限性。我们比较了25G玻璃体切除术治疗增生性糖尿病性视网膜病变（PDR）眼中难治性糖尿病黄斑水肿伴或不伴有牵拉性增殖膜的1年结果，并研究了术后视力的预后因素。对6个中心连续116例因牵拉性黄斑水肿（TME组：56只眼）或非牵拉性黄斑水肿（nTME组：60只眼）接受25G玻璃体切除术的PDR患者的116只眼进行了回顾性研究。比较了玻璃体切除术前和术后12个月的视力（VA）、中心黄斑厚度（CMT）、并发症及术后治疗情况。每组的平均视力均显著提高（均P<0.01），每组的平均CMT均显著降低（均P<0.01）。13只眼接受了再次玻璃体切除术，6只眼发生了新生血管性青光眼，6只眼接受了玻璃体内抗VEGF注射，13只眼接受了球后曲安奈德注射。多元线性回归分析显示，TME组的基线视力和CMT以及nTME组的肾功能是术后12个月视力的可预测因素。25G玻璃体切除术在TME组和nTME组均有效改善了视力和黄斑结构。基线视力、CMT和肾功能是影响术后视力的重要因素。
