Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Ophthalmology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea.
Sci Rep. 2021 Jan 14;11(1):1292. doi: 10.1038/s41598-020-80350-w.
This retrospective, consecutive interventional study investigated the long-term clinical outcomes of combined vitrectomy with intraoperative dexamethasone implants for non-tractional refractory diabetic macular edema (DME). The study included 43 eyes from 39 participants with DME that had continued for more than 6 months despite repeated non-surgical treatment. Postoperative changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated over 3 years. A Kaplan-Meier curve was obtained for any additional non-surgical treatment, and the average number of non-surgical treatments required for DME before and after surgery was compared. Other postsurgical complications were also investigated. The logMAR BCVA improved from 0.526 ± 0.417 (20/67) preoperatively to 0.294 ± 0.374 (20/39) 3 years postoperatively (p < 0.001, generalized estimating equation). The CMT improved from 478 ± 122 μm preoperatively to 314 ± 90 μm 3 years postoperatively (p < 0.001, generalized estimating equation). Additional non-surgical treatment was not required for 29 (67%) eyes. The average number of annual non-surgical treatments decreased from 5.04 times preoperatively to 0.34 times postoperatively. Seventeen (40%) eyes developed temporary ocular hypertension after surgery, which normalized after antihypertensive eye drop instillation. In conclusion, vitrectomy combined with intraoperative dexamethasone implantation provides satisfactory long-term clinical outcomes for non-tractional refractory DME while reducing the number of intraocular injections for DME.
这项回顾性、连续的介入研究调查了玻璃体切除术联合术中地塞米松植入治疗非牵引性难治性糖尿病黄斑水肿（DME）的长期临床结果。该研究纳入了 39 名患者的 43 只眼，这些患者的 DME 持续时间超过 6 个月，尽管接受了多次非手术治疗。在 3 年内评估了最佳矫正视力（BCVA）和中心黄斑厚度（CMT）的术后变化。获得了任何额外非手术治疗的 Kaplan-Meier 曲线，并比较了手术前后 DME 所需的平均非手术治疗次数。还研究了其他术后并发症。术后 3 年，logMAR BCVA 从术前的 0.526 ± 0.417（20/67）提高到 0.294 ± 0.374（20/39）（p<0.001，广义估计方程）。CMT 从术前的 478 ± 122μm 改善至术后 3 年的 314 ± 90μm（p<0.001，广义估计方程）。29 只眼（67%）无需进行额外的非手术治疗。术前每年非手术治疗的平均次数从 5.04 次减少到术后的 0.34 次。术后 17 只眼（40%）发生暂时性眼压升高，经降压眼滴注后恢复正常。总之，玻璃体切除术联合术中地塞米松植入可提供非牵引性难治性 DME 的满意长期临床结果，同时减少 DME 的眼内注射次数。
